Duplikat Akta Nikah [PDF]

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Lampiran 26 KMA No.296 Pasal 39 ayat (1) Model : DN



DUPLIKAT KUTIPAN AKTA NIKAH Akta Nikah Nomor I. Telah dilangsungkan akad nikah Pada hari / tanggal / bulan Tahun (hijri dan masehi) II.



III.



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VII.



VIII.



SUAMI 1. Nama lengkap dan alias 2. Tempat dan tanggal lahir 3. Warga Negara 4. Agama 5. Pekerjaan 6. Tempat tinggal 7. Status sebelum menikah 8. Orang Tua Kandung



ISTRI 1. Nama lengkap dan alias 2. Tempat dan tanggal lahir 3. Warga Negara 4. Agama 5. Pekerjaan 6. Tempat tinggal 7. Status sebelum menikah 8. Orang Tua Kandung



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: Ayah : Ibu



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: Ayah : Ibu



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WALI NIKAH 1. Status Wali (Nasab / Hakim) 2. Hubungan Wali / sebab 3. Nama lengkap dan alias 4. Bin 5. Tempat tanggal lahir 6. Warga Negara 7. Agama 8. Pekerjaan 9. Tempat tinggal



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MAS KAWIN 1. Berupa dan berapa 2. Pembayaran (Tunai/utang)



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PERJANJIAN PERKAWINAN Jika ada sebutkan



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TAKLIK TALAK Sesudah akad nikah, suami membaca dan menanda tangani taklik talak (ya/tidak) :.............................................................................................................................. Jika pencatatan nikah berdasarkan Putusan pengadilan sebutkan 1. Pengadilan yang memtuskan :.............................................................................................................................. 2. Nomor dan tanggal :............................................................................................................................ ..



Makassar,...................................................................... Dikutip sebagai duplikat sesuai dengan akta nikahnya yang mengutip Pegawai Pencatatan Nikah Kecamatan Wajo



H.HASAN SAKARING NIP. 150 007 194