Application For Certificate Of Islamic Marriage

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Application for Certificate of Islamic Marriage
Please answer the following questions and fill out the form completely.
Prospective husband’s information:
:
_________________________________________________________________
First, Middle and Family Name
Father’s full name:
Mother’s full name:
_______________________________
_____________________
__
_
Religious affiliation (specify sect such as “Muslim, Twelver Shi‘ah):
Date of Birth:
__
Place of Birth:
___________________________
_
___________________________________
_
Primary nationality:
______________________________
Seconda
:
_______________________
ry nationality
Current marital status:
(Check one)
□.
ingle
,
arried
,
ivorced
,
idower
S
M
D
W
Postal address:
___________
____________
_
________________________________________________________
_
Home phone:
_____________________
___
Cell phone:
____________________________
_
___________
__
Email address:
_______________________
_
_________________________________________________________
Prospective wife’s information:
:
_________________________________________________________________
First, Middle and Family Name
Father’s full name:
Mother’s full name:
_______________________________
_____________________
__
_
Religious affiliation (specify sect such as “Muslim, Twelver Shi‘ah):
Date of Birth:
__
Place of Birth:
___________________________
_
___________________________________
_
Primary nationality:
______________________________
Seconda
:
_______________________
ry nationality
Current marital status:
(Check one)
□.
ingle
,
arried
,
ivorced
,
idower
S
M
D
W
Postal address:
___________
____________
_
________________________________________________________
_
Home phone:
_____________________
___
Cell phone:
____________________________
_
___________
__
Email address:
_______________________
_
_________________________________________________________
Marriage Application_06152009 | Imam Mahdi Association of Marjaeya | | Page 1 of 3

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