SURAT IZIN PERSETUJUAN ORANG TUA (PRA NIKAH)


SURAT IZIN PERSETUJUAN ORANG TUA

Kami yang bertanda tangan dibawah ini:

Ayah Kandung
1. Nama Lengkap                      : ..........................................................................................
2. Jenis Kelamin                       : ..........................................................................................
3. Tempat/ Tanggal Lahir          : ..........................................................................................
4. Kewarganegaraan                 : ..........................................................................................
5. Agama                                  : ..........................................................................................
6. Pekerjaan                              : ..........................................................................................
7. Tempat Tinggal                     : ..........................................................................................
Ibu Kandung
1.Nama Lengkap                       : ..........................................................................................
2. Jenis Kelamin                       : ..........................................................................................
3. Tempat/ Tanggal Lahir          : ..........................................................................................
4. Kewarganegaraan                 : ..........................................................................................
5. Agama                                  : ..........................................................................................
6. Pekerjaan                              : ..........................................................................................
7. Tempat Tinggal                     : ..........................................................................................

Dengan ini memberikan izin/ persetujuan untuk pernikahan kepada anak kami :
1. Nama Lengkap                      : ..........................................................................................
2. Jenis Kelamin                       : ..........................................................................................
3. Tempat Tanggal Lahir           : ..........................................................................................
4. Kewarganegaraan                 : ..........................................................................................
5. Agama                                  : ..........................................................................................
6. Pekerjaan                              : ..........................................................................................
7. Tempat Tinggal                     : ..........................................................................................
Dengan seorang laki-laki/perempuan:
1. Nama Lengkap                      : ..........................................................................................
2. Jenis Kelamin                       : ..........................................................................................
3. Tempat Tanggai Lahir           : ..........................................................................................
4. Kewarganegaraan                 : ..........................................................................................
5. Agama                                  : ..........................................................................................
6. Pekerjaan                              : ..........................................................................................
7. Tempat Tinggal                     : ..........................................................................................


                                                                                                            Pekanbaru,………………

Yang member IZIN/ PERSETUJUAN
Ayah Kandung                                                                        Ibu Kandung



(..........................................)                                                            (..........................................)
Nama Lengkap & Tanda Tangan                                                                Nama Lengkap & Tanda Tangan

Persyaratan
1.     Pas foto 3x4                                  : 2 Lembar
2.     Fotocopy KTP                              : 2 Lembar
3.     Fotocopy KTP Orang Tua            : 1 Lembar
4.     Fotocopy KTP Saksi                     : 1 Lembar
5.     Fotocopy Kartu Kelunrga : 2 Lembar
6.     Fotocopy Formulir Isian               : 1 Lembar  

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