KOMISI KATEKISASI GKI KEBAYORAN BARU

PERMOHONAN UNTUK MENGIKUTI PEMBINAAN PRANIKAH

DI GEREJA KRISTEN INDONESIA KEBAYORAN BARU
I. CALON SUAMI :
1. Nama lengkap : .........................................................................................................................................
2. Tempat/tgl. lahir : .......................................................................................................................................
3. Alamat Jelas : .......................................................................................................................................
: ......................................... Telp.: ...................................... HP.........................................
4. Anggota Gereja : .......................................................................................................................................
5. Pekerjaan : .......................................................................................................................................
6. Orang tua : .......................................................................................................................................
Nama Ayah : .......................................................................................................................................
Anggota Gereja : .......................................................................................................................................
Nama Ibu : .......................................................................................................................................
Anggota Gereja : .......................................................................................................................................
7. Alamat Orang tua : .......................................................................................................................................
: ....................................................................... Telp.: ........................................................

II. CALON ISTRI:

1. Nama lengkap : .........................................................................................................................................
2. Tempat/tgl. lahir : .......................................................................................................................................
3. Alamat Jelas : .......................................................................................................................................
: ......................................... Telp.: ...................................... HP.........................................
4. Anggota Gereja : .......................................................................................................................................
5. Pekerjaan : .......................................................................................................................................
6. Orang tua : .......................................................................................................................................
Nama Ayah : .......................................................................................................................................
Anggota Gereja : .......................................................................................................................................
Nama Ibu : .......................................................................................................................................
Anggota Gereja : .......................................................................................................................................
7. Alamat Orang tua : .......................................................................................................................................
: ....................................................................... Telp.: ........................................................

Mohon mengikuti Pembinaan Pranikah di Gereja Kristen Indonesia Kebayoran Baru dan kami berjanji akan
mematuhi ketentuan-ketentuan yang ada dan akan setia mengikuti sampai selesai.

Jakarta,...................................................

Pemohon I, Pemohon II

Foto Foto
3x4 3x4
( ...................................................... ) ( ............................................................ )
Catatan : Foto 3 x 4 (2 lembar)