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Civil Office Form

Two individuals, identified by their names and addresses, are reporting to the Chief of the Civil Registry Office in Badung Municipality that they intend to get married. They are requesting that their information be registered and the marriage be announced accordingly. The document is dated August 20, 2015 and is signed by both individuals.

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97 views3 pages

Civil Office Form

Two individuals, identified by their names and addresses, are reporting to the Chief of the Civil Registry Office in Badung Municipality that they intend to get married. They are requesting that their information be registered and the marriage be announced accordingly. The document is dated August 20, 2015 and is signed by both individuals.

Uploaded by

InfinityXpeed
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOC, PDF, TXT or read online on Scribd
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To

The Chief Of Civil

Registry Office

Badung Municipality

I, (The Undersigned) born at on


,
Religion . Occupation . Permanent address
. Previously married: . Son of
address
And address

Together with
born at on
Religion: . Occupation: . Permanent address:
. Previously married: .Daughter of
address and
address
Here with report to the Chief of the Civil Registry Office Badung Municipality. That we intend to
marry and request that information be registered and announced accordingly.

Denpasar, 20 August 2015

(
)

(
)
Solemnization on -

Date : 20 August 2015

Day : Thursday Time : 10.00

NO QUESTION ANSWER

II. GROOM TO BE
1. Name :
2. Nationality :
3. Place and date of Birth :
4. Religion :
5. Occupation :
6. Present address :
7. Previous :
8. Marital status :
9. Ex Wife Name :

II. FATHER OF THE GROOM TO BE


1. Name :
2. Age :
3. Religion :
4. Occupation :
5. Address :

III. MOTHER OF THE GROOM TO BE


1. Name :
2. Age :
3. Religion :
4. Occupation :
5. Address :

IV. BRIDE TO BE
1. Name :
2. Nationality :
3. Place and date of birth :
4. Religion :
5. Occupation :
6. Present address :
7. Previous :
8. Marital Status :
9. Ex. Husbans name :

V. FATHER OF THE BRIDE TO BE


1. Name :
2. Age :
3. Religion :
4. Occupation :
5. Address :
VI. MOTHER OF BRIDE TO BE
1. Name :
2. Age :
3. Religion :
4. Occupation :
5. Address :

VII. FIRST WITNESS


1. Name :
2. Age :
3. Religion :
4. Occupation :
5. Address :

VIII. SECOND WITNESS


1. Name :
2. Age :
3. Religion :
4. Occupation :
5. Address :

Denpasar, 28 December 2014

( )

( )

Signature of witnesses:

I Name of witness 1.

II Name of witness 2.

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