Hal : Pemberitahuan Nikah dan

Mohon surat Penyerahan Nikah

Kepada Yth.
Majelis Gereja Kristen Jawa Kabluk
Jl. Brigjen S. Sudiarto 140.A
Semarang – 50161

Dengan hormat.
Melalui surat ini, perkenankan kami,
Nama : .................................................................................................................
Alamat : .................................................................................................................
.................................................................................................................
Anggota Gereja : .................................................................................................................
Dan
Nama : .................................................................................................................
Alamat : .................................................................................................................
.................................................................................................................
Anggota Gerja : .................................................................................................................
Memberitahukan bahwa kami berdua hendak melangsukan pernikahan gerejawi pada :

Hari, Tanggal : .................................................................................................................

Jam : .................................................................................................................
Tempat : .................................................................................................................
Dan Nikah BS/Catatan Sipil
Hari, Tanggal : .................................................................................................................
Jam : .................................................................................................................
Tempat : .................................................................................................................
Sehubungan dengan hal di atas, maka perkenankan kami mohon surat penyerahan nikah yang ditujukan kepada
Majelis .........................................................................................................................................................................

Demikian pemberitahuan dan permohonan kami, atas perhatian dan perkenannya kami mengucapkan terima
kasih.

Semarang, ..............................................
Hormat kami,

_________________________ ____________________________
Mempelai Pria Mempelai Wanita
Mengetahui dan Menyetujui

_________________________ ____________________________
Orangtua/Wali Mempelai Pria Prangtua/Wali Mempelai Wanita

*halaman 1
 DATA DIRI
CALON MEMPELAI PRIA

Nama : .................................................................................................................
Tempat, tanggal lahir : .................................................................................................................
Alamat : .................................................................................................................
.................................................................................................................
Agama : .................................................................................................................
Amggota Gereja : .................................................................................................................
Tempat, tanggal Baptis : .................................................................................................................
Tempat, tanggal Sidi : .................................................................................................................
Status : Jejaka / Duda *)
Pekerjaan : .................................................................................................................
Nama Ayah : .................................................................................................................
Ibu : .................................................................................................................

Semarang, ................................
Calon mempelai pria,

( ............................................... )

CALON MEMPELAI WANITA

Nama : .................................................................................................................
Tempat, tanggal lahir : .................................................................................................................
Alamat : .................................................................................................................
.................................................................................................................
Agama : .................................................................................................................
Amggota Gereja : .................................................................................................................
Tempat, tanggal Baptis : .................................................................................................................
Tempat, tanggal Sidi : .................................................................................................................
Status : Perawan / Janda *)
Pekerjaan : .................................................................................................................
Nama Ayah : .................................................................................................................
Ibu : .................................................................................................................

Semarang, ................................
Calon mempelai Wanita,

( ............................................... )

*) Coret yang tidak perlu

Pn – 2
*halaman 2