Nova Elm Academy (NEA)
44900 Acacia Lane, Suite 101
Sterling, VA 20166
Phone: (571) 313-1300
Email: admin@NovaElmAcademy.org
Website: www.NovaElmAcademy.org
Nikah Application Form
Please complete this form in full, giving specific and detailed information where necessary. This
information will be handled with respect to everyone’s privacy. Please print clearly.
Groom Bride
First Name:
Middle Name:
Last Name:
Date of Birth:
Address:
Phone:
Email:
Current Marital Status: Single Married Single Married
Divorced Widower Divorced Widow
Passport No/ID No:
Amount of Dowry
(Mahr Agreed):
Wali Information:
First Name: Last Name:
Street Address:
City: State: Zip Code:
Phone: Email:
Relationship to Bride:
Nova Elm Academy (NEA)
44900 Acacia Lane, Suite 101
Sterling, VA 20166
Phone: (571) 313-1300
Email: admin@NovaElmAcademy.org
Website: www.NovaElmAcademy.org
First Witness Information:
First Name: Last Name:
Street Address:
City: State: Zip Code:
Phone: Email:
Second Witness Information:
First Name: Last Name:
Street Address:
City: State: Zip Code:
Phone: Email:
Marriage Information:
Has this marriage been registered? Yes (You must provide registration information)
Date of Marriage:
Name of Registering
Office:
Registration Number:
No
Has this bride been married before? Yes (You must provide proof of Islamic divorce)
No
Official Use Only (Do not write in this section):
Date of Nikah: Nikah Performed By:
Nova Elm Academy (NEA)
44900 Acacia Lane, Suite 101
Sterling, VA 20166
Phone: (571) 313-1300
Email: admin@NovaElmAcademy.org
Website: www.NovaElmAcademy.org
Nikah Requirements:
Please ensure you bring the relevant documents with you on the day of Nikah:
1. Both bride and groom must be present in person on the day of Nikah.
2. Wali must be present in person.
Wali must be the father of the bride unless he is deceased (if there are any issues with this
please call the office to discuss). If Wali is abroad, he must give power of attorney
appointing someone else to act as Wali on their behalf. Power of attorney should clearly
state the name of the father of the bride, his Passport/Photo ID number, and his consent for
his daughter to marry the groom.
3. Valid Marriage license if acquired.
4. Valid Passport/Photo ID for all three (Groom, Bride and her Wali).
5. Two adult male Muslim witnesses and their Passport/Photo IDs.
6. If the bride has previously been married then, she should present proof of her Islamic divorce.
A recommended fee of $250.00 to be paid to Nova Elm Academy (NEA) for this service. Any additional
contributions are greatly appreciated as NEA is a Non-Profit Organization that operates solely on the
generosity of people like you. Indeed Allah (SW) will reward you manifold for your contributions to his
house.
If the above requirements cannot be met, Nova Elm Academy (NEA) reserves the right to refuse to
perform the Nikah.
I testify in the name of Allah that the information given on the application for booking Nikah
is true to the best of my knowledge and belief.
Groom’s Name: ______________________________________________
Groom’s Signature: ___________________________________________ Date: ___/____/____
Bride’s Name: ______________________________________________
Bride’s Signature: ___________________________________________ Date: ___/____/____
