IN THE NAME OF ALLAH

THE MERCIFUL THE COMPASIONATE

Municipal Form No. 97
(Revised January 1993, attachment)

Province_____________________ Registry No. _______________

City/Municipality _______________________
DATE OF MARRIAGE (Day) (Month) (Year) MARRIAGE ORDER (whether first, second, etc.)
Gregorian Calendar: ___________________________ Husband: ______________________________
Hijrah Calendar: ______________________________ Wife: __________________________________
AMOUNT OF MAHR (Dowry) OTHER STIPULATIONS TO THE MARRIAGE
Cash ____________________________________
(whether husband delegates the right of talaq/tafwid to
the wife, etc.) ____________________________________
Others (specify) ________________________
_____________________________________________________________________________________
CONTACTING PARTIES: Husband Wife
SIGNATURE : ___________________________ ___________________________________
PRINTED NAME : ____________________________ ____________________________________

IN THE NAME OF ALLAH

THE MERCIFUL THE COMPASIONATE
Municipal Form No. 97
(Revised January 1993, attachment)

Province_____________________ Registry No. _______________

City/Municipality _______________________
DATE OF MARRIAGE (Day) (Month) (Year) MARRIAGE ORDER (whether first, second, etc.)

Gregorian Calendar: ___________________________ Husband: ______________________________

Hijrah Calendar: ______________________________ Wife: __________________________________
AMOUNT OF MAHR (Dowry) OTHER STIPULATIONS TO THE MARRIAGE
Cash ____________________________________
(whether husband delegates the right of talaq/tafwid to
the wife, etc.) ____________________________________
Others (specify) ________________________
_____________________________________________________________________________________
CONTACTING PARTIES: Husband Wife
SIGNATURE : ___________________________ ___________________________________
PRINTED NAME : ____________________________ ____________________________________