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E.

SAKSI
1. Nama : .................................................................................
NIK : .................................................................................
Tempat Tanggal Lahir : .................................................................................
Warga Negara : .................................................................................
Agama : .................................................................................
Alamat : .................................................................................

2. Nama : .................................................................................
NIK : .................................................................................
Tempat Tanggal Lahir : .................................................................................
Warga Negara : .................................................................................
Agama : .................................................................................
Alamat : ........................................................................................

Calon Suami Calon Istri Wali Nikah

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Saksi I Saksi II Petugas

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