E Nikah

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Formulir Pendaftar E-Nikah

Kantor Urusan Agama Kec. Banjar
Kabupaten Pandeglang - Banten

• Nama Calon Suami *
• No KTP / NIK *
• Bin / Anak dari *
• Tanggal Lahir
  MM / DD / YYYY
• Status *
  Jejaka

  Duda Talak / Cerai

  Duda Mati

  Beristeri 1, 2, 3
• Desa / Kelurahan
• Alamat Lengkap
  Street Address Address Line 2 City State / Province / Region Postal / Zip Code  Antigua and BarbudaArubaBahamasBarbadosBelizeCanadaCayman IslandsCook IslandsCosta RicaCubaDominicaDominican RepublicEl SalvadorGrenadaGuatemalaHaitiHondurasJamaicaMexicoNetherlands AntillesNicaraguaPanama Puerto Rico Saint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesTrinidad and TobagoUnited StatesArgentinaBoliviaBrazilChileColombiaEcuadorGuyanaParaguayPeruSurinameUruguayVenezuelaAlbaniaAndorraArmeniaAustriaAzerbaijanBelarusBelgiumBosnia and HerzegovinaBulgariaCroatiaCyprusCzech RepublicDenmarkEstoniaFaroe IslandsFinlandFranceGeorgiaGermanyGreeceHungaryIcelandIrelandItalyKosovoLatviaLiechtensteinLithuaniaLuxembourgMacedoniaMaltaMoldovaMonacoMontenegroNetherlandsNorwayPolandPortugalRomaniaSan MarinoSerbiaSlovakiaSloveniaSpainSwedenSwitzerlandUkraineUnited KingdomVatican CityAfghanistanBahrainBangladeshBhutanBrunei DarussalamMyanmarCambodiaChinaEast TimorHong KongIndiaIndonesiaIranIraqIsraelJapanJordanKazakhstanNorth KoreaSouth KoreaKuwaitKyrgyzstanLaosLebanonMalaysiaMaldivesMongoliaNepalOmanPakistanPalestinePhilippinesQatarRussiaSaudi ArabiaSingaporeSri LankaSyriaTaiwanTajikistanThailandTurkeyTurkmenistanUnited Arab EmiratesUzbekistanVietnamYemenAustraliaFijiKiribatiMarshall IslandsMicronesiaNauruNew ZealandPalauPapua New GuineaSamoaSolomon IslandsTongaTuvaluVanuatuAlgeriaAngolaBeninBotswanaBurkina FasoBurundiCameroonCape VerdeCentral African RepublicChadComorosDemocratic Republic of the CongoRepublic of the CongoDjiboutiEgyptEquatorial GuineaEritreaEthiopiaGabonGambiaGhanaGibraltarGuineaGuinea-BissauCote d'IvoireKenyaLesothoLiberiaLibyaMadagascarMalawiMaliMauritaniaMauritiusMoroccoMozambiqueNamibiaNigerNigeriaRwandaSao Tome and PrincipeSenegalSeychellesSierra LeoneSomaliaSouth AfricaSudanSwazilandUnited Republic of TanzaniaTogoTunisiaUgandaZambiaZimbabwe Country / Region
  
• Nomor Handphone
• Alamat Email
• Nama Calon Isteri *
• No KTP / NIK
• Binti / Anak dari *
• Tanggal lahir calon isteri *
  MM / DD / YYYY
• Status
  Perawan

  Janda Cerai Gugat

  Janda Talak

  Janda Mati
• Desa / Kelurahan
• Alamat Lengkap
  Street Address Address Line 2 City State / Province / Region Postal / Zip Code  Antigua and BarbudaArubaBahamasBarbadosBelizeCanadaCayman IslandsCook IslandsCosta RicaCubaDominicaDominican RepublicEl SalvadorGrenadaGuatemalaHaitiHondurasJamaicaMexicoNetherlands AntillesNicaraguaPanama Puerto Rico Saint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesTrinidad and TobagoUnited StatesArgentinaBoliviaBrazilChileColombiaEcuadorGuyanaParaguayPeruSurinameUruguayVenezuelaAlbaniaAndorraArmeniaAustriaAzerbaijanBelarusBelgiumBosnia and HerzegovinaBulgariaCroatiaCyprusCzech RepublicDenmarkEstoniaFaroe IslandsFinlandFranceGeorgiaGermanyGreeceHungaryIcelandIrelandItalyKosovoLatviaLiechtensteinLithuaniaLuxembourgMacedoniaMaltaMoldovaMonacoMontenegroNetherlandsNorwayPolandPortugalRomaniaSan MarinoSerbiaSlovakiaSloveniaSpainSwedenSwitzerlandUkraineUnited KingdomVatican CityAfghanistanBahrainBangladeshBhutanBrunei DarussalamMyanmarCambodiaChinaEast TimorHong KongIndiaIndonesiaIranIraqIsraelJapanJordanKazakhstanNorth KoreaSouth KoreaKuwaitKyrgyzstanLaosLebanonMalaysiaMaldivesMongoliaNepalOmanPakistanPalestinePhilippinesQatarRussiaSaudi ArabiaSingaporeSri LankaSyriaTaiwanTajikistanThailandTurkeyTurkmenistanUnited Arab EmiratesUzbekistanVietnamYemenAustraliaFijiKiribatiMarshall IslandsMicronesiaNauruNew ZealandPalauPapua New GuineaSamoaSolomon IslandsTongaTuvaluVanuatuAlgeriaAngolaBeninBotswanaBurkina FasoBurundiCameroonCape VerdeCentral African RepublicChadComorosDemocratic Republic of the CongoRepublic of the CongoDjiboutiEgyptEquatorial GuineaEritreaEthiopiaGabonGambiaGhanaGibraltarGuineaGuinea-BissauCote d'IvoireKenyaLesothoLiberiaLibyaMadagascarMalawiMaliMauritaniaMauritiusMoroccoMozambiqueNamibiaNigerNigeriaRwandaSao Tome and PrincipeSenegalSeychellesSierra LeoneSomaliaSouth AfricaSudanSwazilandUnited Republic of TanzaniaTogoTunisiaUgandaZambiaZimbabwe Country / Region
  
• Alamat e-mail
• Nama Wali *
• Tanggal dan Jam Akad Nikah *
  MM / DD / YYYY HH : MM AMPM AM/PM
• Tempat Pelaksanaan Akad Nikah
  Silahkan pilihBalai Nikah KUARumah Gedung
• Jika di luar balai nikah, tuliskan alamat lengkapnya di sini
• Notifikasi
  Setuju

  Saya menyatakan bahwa data yang di entry dalam form ini adalah benar dan dokumen asli persyaratan nikah akan saya kirimkan ke KUA dalam waktu dekat.

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