CONTOH SURAT KETERANGAN WALI

SURAT KETERANGAN WALI

       Yang bertanda tangan dibawah ini Pembantu PPN Desa / Kelurahan Ligung Lor Kecamatan Ligung Kabupaten  Majalengka menerangkan bahwa :

Nama lengkap            :  .........................................................................................................

Bin                                                :  .........................................................................................................

Tempat & Tgl, lahir   :   ........................................................................................................

Warga Negara             :  Indonesia

Pendidikan                  : .........................................................................................................

A g a m a                     : Islam

Pekerjaan                    :  .........................................................................................................

         A l a m a t                    : Dusun................  RT......... RW...........  Desa Ligung Lor Kec. Ligung

                                          Kabupaten Majalengka.

Adalah betul wali nikah seorang perempuan :

Nama lengkap            :  .........................................................................................................

Bin                                                :  .........................................................................................................

Tempat & Tgl, lahir   :   ........................................................................................................

Warga Negara             : Indonesia

Pendidikan                  : .........................................................................................................

A g a m a                     : Islam

Pekerjaan                    :  .........................................................................................................

         A l a m a t                    : Dusun................  RT......... RW...........  Desa Ligung Lor Kec. Ligung

                                          Kabupaten Majalengka.

Sebagai wali/Nasab/Hakim* hubungan wali/sebab ........................................... Perempuan tersebut di atas akan kawin dengan seorang laki-laki :

Nama lengkap            :  .........................................................................................................

Bin                                                :  .........................................................................................................

Tempat & Tgl, lahir   :   ........................................................................................................

Warga Negara             : Indonesia

Pendidikan                  : .........................................................................................................

A g a m a                     : Islam

Pekerjaan                    :  .........................................................................................................

         A l a m a t                    : Blok ................  RT......... RW...........  Desa ................... Kec. ................

                                          Kabupaten .............................................

                                                                                    Beusi , ......................................

         Tanda Tangan Yang Bersangkutan                                      Kepala Desa  Beusi

          (.......................................................)                                          ………………..