Municipal Form No.

97
(Revised January 2004, attachment)

Province_____________________ Registry No. _______________

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

Husband: ______________________________
Wife: ________________________________
AMOUNT OF DOWRY OTHER STIPULATIONS TO THE MARRIAGE
Cash ______________________________ (whether husband delegates the right of talaq/tafwid to
Others (specify) ________________________the wife, etc.) ________________________________
_________________________________________ ________________________________________
CONTACTING PARTIES: Husband Wife
SIGNATURE : ___________________________ _________________________________
PRINTED NAME : ____________________________ _________________________________
ETHNIC AFFILIATION OF THE HUSBAND ETHNIC AFFILIATION OF THE WIFE

Municipal Form No. 97

(Revised January 2004, attachment)

Province_____________________ Registry No. _______________

City/Municipality _______________________

DATE OF MARRIAGE (Day) (Month) (Year) MARRIAGE ORDER (whether first, second, etc.)

Husband: ______________________________
Wife: ________________________________
AMOUNT OF DOWRY OTHER STIPULATIONS TO THE MARRIAGE
Cash ______________________________ (whether husband delegates the right of talaq/tafwid to
Others (specify) ________________________the wife, etc.) ________________________________
_________________________________________ ________________________________________
CONTACTING PARTIES: Husband Wife
SIGNATURE : ___________________________ _________________________________
PRINTED NAME : ____________________________ _________________________________
ETHNIC AFFILIATION OF THE HUSBAND ETHNIC AFFILIATION OF THE WIFE