Sebagal waIUnasablhe+!

im;') as nasab / judge guardian;') CATATAN STATUS PERKAWINAN

dengan mas kawin berupa I With the dowry tn term of: NOTE OF MARITAL STATUS

.l/AI'IJ...~ ..'".$,O:QQQ.~.~ ..
tunai/hlileltg'): I cash/indebted'): dengan pe~anjian nikah : yaJ tldak .)
by wedding engagement yes / no 'j
Sesudah akad nikah suami mengucapkan I membaca dan
menandatangani takfik talak : ya I tidak ') I After the marriage ceremony
was done the husband uttered/read and signed the taklik talak 'yeslno')

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lsi sesuai dengan akta nikah
Contents are pursuans 10 the marriage certificate
KUA Kecamatan I KUA District
Perwakllan RI / Indonesian Embassy')

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Registration Office

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