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[]
[{"$nulls":32},"F-2.01"]
[null,"Provinsi",null,null,null,":",null,"KALIMANTAN BARAT"]
[]
[null,"Kabupaten/Kota",null,null,null,":",null,"SINTANG"]
[]
[null,"Kecamatan",null,null,null,":"]
[]
[null,"Desa/Kelurahan",null,null,null,":",{"$nulls":14},"Email**",null,null,":"]
[]
[null,"Kode Wilayah",null,null,null,":",{"$nulls":14},"No.Handphone**",{"$nulls":6},":"]
[]
[null,"FORMULIR PELAPORAN PENCATATAN SIPIL DI DALAM WILAYAH NKRI"]
[null,"Jenis Pelaporan Pencatatan Sipil"]
[]
[]
[null,null,"Kelahiran",{"$nulls":15},"Pengakuan Anak"]
[]
[null,null,"Lahir Mati",{"$nulls":15},"Pengesahan Anak"]
[]
[null,"√","Perkawinan",{"$nulls":15},"Perubahan Nama"]
[]
[null,null,"Pembatalan Perkawinan",{"$nulls":15},"Perubahan Status Kewarganegaraan"]
[]
[null,null,"Perceraian",{"$nulls":15},"Pencatatan Peristiwa Penting Lainnya"]
[]
[null,null,"Pembatalan Perceraian",{"$nulls":15},"Pembetulan Akta"]
[]
[null,null,"Kematian",{"$nulls":15},"Pembatalan Akta"]
[]
[null,null,"Pengangkatan Anak",{"$nulls":15},"Pelaporan Pencatatan Sipil dari Luar Wilayah NKRI"]
[]
[null,"DATA PELAPOR**"]
[]
[null,"Nama",null,null,null,":"]
[]
[null,"NIK",null,null,null,":"]
[]
[null,"Nomor Dokumen Perjalanan*",null,null,null,":"]
[]
[null,"Nomor Kartu Keluarga",null,null,null,":"]
[]
[null,"Kewarganegaraan",null,null,null,":"]
[]
[]
[null,"DATA SUBJEK AKTA KESATU (DATA SUAMI)**"]
[]
[null,"Nama",null,null,null,":"]
[]
[null,"NIK",null,null,null,":"]
[]
[null,"Nomor Dokumen Perjalanan*",null,null,null,":"]
[]
[null,"Nomor Kartu Keluarga",null,null,null,":"]
[]
[null,"Kewarganegaraan",null,null,null,":"]
[]
[]
[null,"DATA SUBJEK AKTA KEDUA (DATA ISTERI)**"]
[]
[null,"Nama",null,null,null,":"]
[]
[null,"NIK",null,null,null,":"]
[]
[null,"Nomor Dokumen Perjalanan*",null,null,null,":"]
[]
[null,"Nomor Kartu Keluarga",null,null,null,":"]
[]
[null,"Kewarganegaraan",null,null,null,":"]
[]
[]
[null,"DATA SAKSI I**"]
[]
[null,"Nama",null,null,null,":"]
[]
[null,"NIK",null,null,null,":"]
[]
[null,"Nomor Kartu Keluarga",null,null,null,":"]
[]
[null,"Kewarganegaraan",null,null,null,":"]
[]
[]
[]
[]
[null,"DATA SAKSI II**"]
[]
[null,"Nama",null,null,null,":"]
[]
[null,"NIK",null,null,null,":"]
[]
[null,"Nomor Kartu Keluarga",null,null,null,":"]
[]
[null,"Kewarganegaraan",null,null,null,":"]
[]
[]
[null,"PERKAWINAN ATAU PEMBATALAN PERKAWINAN"]
[]
[null,"1.","NIK Ayah dari Suami",null,null,":"]
[]
[null,"2.","Nama Ayah dari Suami",null,null,":"]
[]
[null,"3.","NIK Ibu dari Suami",null,null,":"]
[]
[null,"4.","Nama Ibu dari Suami",null,null,":"]
[]
[null,"5.","NIK Ayah dari Isteri",null,null,":"]
[]
[null,"6.","Nama Ayah dari Isteri",null,null,":"]
[]
[null,"7.","NIK Ibu dari Isteri",null,null,":"]
[]
[null,"8.","Nama Ibu dari Isteri",null,null,":"]
[]
[null,"9.","Status Perkawinan Sebelum Kawin",null,null,":",null,null,"1.","Kawin",null,null,null,"2.","Belum Kawin",{"$nulls":5},"3.","Cerai Hidup",{"$nulls":5},"4.","Cerai Mati"]
[]
[null,"10.","Perkawinan Yang Ke",null,null,":"]
[]
[null,"11.","Isteri yang Ke-",null,null,":"]
[null,null,"(bagi yang poligami)"]
[]
[null,"12.","Tanggal Pemberkatan Perkawinan",null,null,":",null,"Tgl :",{"$nulls":4},"Bln :",{"$nulls":4},"Thn:"]
[]
[null,"13.","Tanggal Melapor",null,null,":",null,"Tgl :",{"$nulls":4},"Bln :",{"$nulls":4},"Thn:"]
[]
[null,"14.","Jam Pelaporan",null,null,":",null,null,null,":",null,null,"WIB"]
[]
[null,"15.","Agama",null,null,":",null,null,"1.","Islam",null,null,"2.","Kristen",null,null,null,"3.","Katholik",null,null,null,"4.","Hindu",null,null,"5.","Budha",null,null,null,"6.","Konghucu"]
[]
[null,"16.","Kepercayaan",null,null,":"]
[]
[null,"17.","Nama Organisasi Kepercayaan",null,null,":"]
[]
[null,"18.","Nama Pengadilan",null,null,":"]
[]
[null,"19.","Nomor Penetapan Pengadilan",null,null,":"]
[]
[null,"20.","Tanggal Penetapan Pengadilan",null,null,":",null,"Tgl :",{"$nulls":4},"Bln :",null,null,null,"Thn:"]
[]
[null,"21.","Nama Pemuka Agama/Kepercayaan",null,null,":"]
[]
[null,"22.","Nomor Surat Izin dari Perwakilan",null,null,":"]
[]
[null,"23.","Nomor Pasport",null,null,":"]
[]
[null,"24.","Perjanjian Perkawinan Dibuat Oleh",null,null,":"]
[null,null,"Notaris"]
[]
[null,"25.","Nomor Akta Notaris",null,null,":"]
[]
[null,"26.","Tanggal Akta Notaris",null,null,":"]
[]
[null,"27.","Jumlah Anak (jika ada agar mengisi",null,null,":"]
[null,null,"formulir tambahan anak dan akta"]
[null,null,"kelahiran anak)"]
[]
[null,"Bagi Pemohon Pembatalan Perkawinan Harap Mengisi Data di Bawah ini :"]
[]
[null,"1.","Tanggal Perkawinan",null,null,":",null,"Tgl :",{"$nulls":4},"Bln :",{"$nulls":4},"Thn:"]
[]
[null,"2.","Nomor Akta Perkawinan",null,null,":"]
[]
[null,"3.","Tanggal Akta Perkawinan",null,null,":",null,"Tgl :",{"$nulls":4},"Bln :",{"$nulls":4},"Thn:"]
[]
[]
[]
[]
[]
[]
[null,"4.","Nama Pengadilan",null,null,":"]
[]
[null,"5.","Nomor Putusan Pengadian",null,null,":"]
[]
[null,"6.","Tanggal Putusan Pengadilan",null,null,":",null,"Tgl :",{"$nulls":4},"Bln :",{"$nulls":4},"Thn:"]
[]
[null,"7.","Tanggal Pelaporan Perkawinan",null,null,":",null,"Tgl :",{"$nulls":4},"Bln :",{"$nulls":4},"Thn:"]
[null,null,"di Luar Negeri"]
[]
[]
[]
[]
[null,null,"Mengetahui :",{"$nulls":18},"………………, ………………………. 20 …"]
[null,null,"Kepala Desa/Lurah",{"$nulls":18},"Pelapor,"]
[null,null,"Pejabat Dukcapil Yang Membidangi,"]
[]
[]
[]
[null,null,"( ………………………………………………… )",{"$nulls":19},"( …………………………………………… )",{"$nulls":11},"**"]
[]
[null,"*","Jika ada"]
[null,"**","Wajib diisi"]
[]
[]
[null,"PERSYARATAN AKTA PERKAWINAN :"]
[]
[null,null,"Mengisi Formulir Pencatatan Perkawinan"]
[]
[null,null,"Surat Keterangan Perkawinan dari Pemuka Agama/Penghayat Kepercayaan/Salinan Penetapan Pengadilan di Legalisir"]
[]
[null,null,"Pejabat yang berwenang"]
[]
[null,null,"Fotocopy Kutipan Akta Kelahiran Suami dan Isteri yang di Legalisir (bagi yang belum menggunakan barcode)."]
[]
[null,null,"Surat Keterangan dari Desa / Kelurahan (Suami, Orang Tua Suami, Isteri, Orang Tua Isteri)"]
[]
[null,null,"Fotocopy KTP-el dan KK Suami dan Isteri"]
[]
[null,null,"Pas Photo Berdampingan Ukuran 4x6 cm sebanyak 5 lembar (latar belakang biru, suami disebelah kanan)"]
[]
[null,null,"Fotocopy KTP-el 2 (dua) orang saksi yang telah berusia 21 tahun keatas"]
[]
[null,null,"Fotocopy Kutipan Akta Kelahiran Anak yang akan diakui / disyahkan (Legalisir (bagi yang belum menggunakan "]
[null,null,"barcode))"]
[]
[null,null,"Fotocopy Akta Perceraian/Kematian jika yang bersangkutan pernah kawin*)"]
[]
[null,null,"Ijin Komandan bagi Anggota TNI / Polri*)"]
[]
[null,null,"Perjanjian Perkawinan*)"]
[]
[null,null,"STMD dari Kepolisian*)"]
[]
[null,null,"Surat Ijin dari Isteri bagi yang berpoligami*)"]
[]
[null,null,"Surat Ijin dari Pengadilan bagi yang berpoligami*)"]
[]
[null,null,"Surat Ijin dari Perwakilan Negara Asing yang bersangkutan*)"]
[]
[null,null,"Paspor / Dokumen Keimigrasian*)"]
[]
[null,null,"SKTT dari Dinas Kependudukan dan Pencatatan Sipil*)"]
[]
[null,null,"Surat Keterangan dari Dinas Kependudukan dan Pencatatan Sipil Daerah Asal bagi Penduduk Luar Kabupaten"]
[]
[null,null,"Surat Kuasa bagi yang kepengurusannya dilakukan oleh orang lain"]
[]
[{"$nulls":10},"Pas Photo Berdampingan ( 4 x 6 )"]
[]
[]
[]
[]
[]
[null,null,null,"DESA / KELURAHAN",null,":",null,"………………………………………………………………………….."]
[null,null,null,"KECAMATAN",null,":",null,"………………………………………………………………………….."]
[null,null,null,"KABUPATEN",null,":",null,"………………………………………………………………………….."]
[]
[]
[null,"SURAT KETERANGAN"]
[{"$nulls":7},"Nomor :"]
[]
[]
[null,"Yang bertanda tangan dibawah ini, Kepala Desa / Kelurahan ……………………………………………… dengan ini menerangkan sesungguhnya :"]
[]
[null,"1.","Nama",null,null,":",null,"……………………………………………………………………………………………………………………."]
[null,"2.","Jenis Kelamin",null,null,":",null,"Laki-laki / Perempuan"]
[null,"3.","Tempat / Tanggal Lahir",null,null,":",null,"……………………………………………………………………………………………………………………."]
[null,"4.","Kewarganegaraan",null,null,":",null,"WNI / WNA"]
[null,"5.","Agama",null,null,":",null,"Islam / Katholik / Kristen / Hindu / Budha / Konghucu"]
[null,"6.","Pekerjaan",null,null,":",null,"Tani / Swasta / PNS / Mengurus Rumah Tangga / Pedagang / ……………………….."]
[null,"7.","Alamat",null,null,":",null,"……………………………………………………………………………………………………………………."]
[]
[null,"Menerangkan yang tersebut diatas adalah benar belum / pernah kawin dan betul penduduk Desa / Kelurahan ……………………….… Kabupaten Sintang"]
[]
[null,"Keterangan ini diberikan atas permintaan yang bersangkutan guna mengurus Akta Perkawinan pada Dinas Kependudukan dan Pencatatan Sipil"]
[]
[null,"Demikian keterangan ini diberikan untuk dapat dipergunakan sebagaimana mestinya."]
[]
[]
[{"$nulls":20},"……………….., ……………………. 20"]
[{"$nulls":20},"Kepala Desa / Lurah"]
[{"$nulls":20},"…………………………………………….,"]
[]
[]
[]
[{"$nulls":20},"………………………………………….."]
[]
[]
[null,"* Untuk Suami"]
{"$rows_empty":14}
[null,null,"DESA / KELURAHAN",null,null,":"]
[null,null,"KECAMATAN",null,null,":"]
[null,null,"KABUPATEN",null,null,":"]
[]
[]
[null,"SURAT KETERANGAN TENTANG ORANG TUA"]
[{"$nulls":4},"Nomor",":"]
[]
[]
[null,"Yang bertanda tangan dibawah ini, Kepala Desa / Kelurahan ………………………….., dengan ini menerangkan sesungguhnya :"]
[]
[null,"1.","Nama",null,null,":",null,"……………………………………………………………………………………………………………………."]
[null,null,"Jenis Kelamin",null,null,":",null,"Laki-laki / Perempuan"]
[null,null,"Tempat / Tanggal Lahir",null,null,":",null,"……………………………………………………………………………………………………………………."]
[null,null,"Kewarganegaraan",null,null,":",null,"WNI / WNA"]
[null,null,"Agama",null,null,":",null,"Islam / Katholik / Kristen / Hindu / Budha / Konghucu"]
[null,null,"Pekerjaan",null,null,":",null,"Tani / Swasta / PNS / Mengurus Rumah Tangga / Pedagang / ……………………….."]
[null,null,"Alamat",null,null,":",null,"……………………………………………………………………………………………………………………."]
[]
[null,"Adalah benar Ayah dari Saudara / Saudari ……………………….."]
[]
[null,"2.","Nama",null,null,":",null,"……………………………………………………………………………………………………………………."]
[null,null,"Jenis Kelamin",null,null,":",null,"Laki-laki / Perempuan"]
[null,null,"Tempat / Tanggal Lahir",null,null,":",null,"……………………………………………………………………………………………………………………."]
[null,null,"Kewarganegaraan",null,null,":",null,"WNI / WNA"]
[null,null,"Agama",null,null,":",null,"Islam / Katholik / Kristen / Hindu / Budha / Konghucu"]
[null,null,"Pekerjaan",null,null,":",null,"Tani / Swasta / PNS / Mengurus Rumah Tangga / Pedagang / ……………………….."]
[null,null,"Alamat",null,null,":",null,"……………………………………………………………………………………………………………………."]
[]
[null,"Adalah benar Ibu dari Saudara / Saudari ……………………….."]
[]
[null,"Demikian keterangan ini dibuat atas permintaan yang bersangkutan guna mengurus Akta Perkawinan pada Dinas Kependudukan dan Pencatatan Sipil."]
[]
[]
[{"$nulls":20},"……………….., ……………………. 20"]
[{"$nulls":20},"Kepala Desa / Lurah"]
[{"$nulls":20},"…………………………………………….,"]
[]
[]
[]
[{"$nulls":20},"………………………………………….."]
[]
[]
[]
[]
[null,"*Untuk Orang Tua Suami"]
[]
[]
[]
[]
[]
[null,null,null,"DESA / KELURAHAN",null,":",null,"………………………………………………………………………….."]
[null,null,null,"KECAMATAN",null,":",null,"………………………………………………………………………….."]
[null,null,null,"KABUPATEN",null,":",null,"………………………………………………………………………….."]
[]
[]
[null,"SURAT KETERANGAN"]
[{"$nulls":7},"Nomor :"]
[]
[]
[null,"Yang bertanda tangan dibawah ini, Kepala Desa / Kelurahan ……………………………………………… dengan ini menerangkan sesungguhnya :"]
[]
[null,"1.","Nama",null,null,":",null,"……………………………………………………………………………………………………………………."]
[null,"2.","Jenis Kelamin",null,null,":",null,"Laki-laki / Perempuan"]
[null,"3.","Tempat / Tanggal Lahir",null,null,":",null,"……………………………………………………………………………………………………………………."]
[null,"4.","Kewarganegaraan",null,null,":",null,"WNI / WNA"]
[null,"5.","Agama",null,null,":",null,"Islam / Katholik / Kristen / Hindu / Budha / Konghucu"]
[null,"6.","Pekerjaan",null,null,":",null,"Tani / Swasta / PNS / Mengurus Rumah Tangga / Pedagang / ……………………….."]
[null,"7.","Alamat",null,null,":",null,"……………………………………………………………………………………………………………………."]
[]
[null,"Menerangkan yang tersebut diatas adalah benar belum / pernah kawin dan betul penduduk Desa / Kelurahan ……………………….… Kabupaten Sintang"]
[]
[null,"Keterangan ini diberikan atas permintaan yang bersangkutan guna mengurus Akta Perkawinan pada Dinas Kependudukan dan Pencatatan Sipil"]
[]
[null,"Demikian keterangan ini diberikan untuk dapat dipergunakan sebagaimana mestinya."]
[]
[]
[{"$nulls":20},"……………….., ……………………. 20"]
[{"$nulls":20},"Kepala Desa / Lurah"]
[{"$nulls":20},"…………………………………………….,"]
[]
[]
[]
[{"$nulls":20},"………………………………………….."]
[]
[]
[null,"* Untuk Isteri"]
{"$rows_empty":14}
[null,null,"DESA / KELURAHAN",null,null,":"]
[null,null,"KECAMATAN",null,null,":"]
[null,null,"KABUPATEN",null,null,":"]
[]
[]
[null,"SURAT KETERANGAN TENTANG ORANG TUA"]
[{"$nulls":4},"Nomor",":"]
[]
[]
[null,"Yang bertanda tangan dibawah ini, Kepala Desa / Kelurahan ………………………….., dengan ini menerangkan sesungguhnya :"]
[]
[null,"1.","Nama",null,null,":",null,"……………………………………………………………………………………………………………………."]
[null,null,"Jenis Kelamin",null,null,":",null,"Laki-laki / Perempuan"]
[null,null,"Tempat / Tanggal Lahir",null,null,":",null,"……………………………………………………………………………………………………………………."]
[null,null,"Kewarganegaraan",null,null,":",null,"WNI / WNA"]
[null,null,"Agama",null,null,":",null,"Islam / Katholik / Kristen / Hindu / Budha / Konghucu"]
[null,null,"Pekerjaan",null,null,":",null,"Tani / Swasta / PNS / Mengurus Rumah Tangga / Pedagang / ……………………….."]
[null,null,"Alamat",null,null,":",null,"……………………………………………………………………………………………………………………."]
[]
[null,"Adalah benar Ayah dari Saudara / Saudari ……………………….."]
[]
[null,"2.","Nama",null,null,":",null,"……………………………………………………………………………………………………………………."]
[null,null,"Jenis Kelamin",null,null,":",null,"Laki-laki / Perempuan"]
[null,null,"Tempat / Tanggal Lahir",null,null,":",null,"……………………………………………………………………………………………………………………."]
[null,null,"Kewarganegaraan",null,null,":",null,"WNI / WNA"]
[null,null,"Agama",null,null,":",null,"Islam / Katholik / Kristen / Hindu / Budha / Konghucu"]
[null,null,"Pekerjaan",null,null,":",null,"Tani / Swasta / PNS / Mengurus Rumah Tangga / Pedagang / ……………………….."]
[null,null,"Alamat",null,null,":",null,"……………………………………………………………………………………………………………………."]
[]
[null,"Adalah benar Ibu dari Saudara / Saudari ……………………….."]
[]
[null,"Demikian keterangan ini dibuat atas permintaan yang bersangkutan guna mengurus Akta Perkawinan pada Dinas Kependudukan dan Pencatatan Sipil."]
[]
[]
[{"$nulls":20},"……………….., ……………………. 20"]
[{"$nulls":20},"Kepala Desa / Lurah"]
[{"$nulls":20},"…………………………………………….,"]
[]
[]
[]
[{"$nulls":20},"………………………………………….."]
[]
[]
[]
[]
[null,"*Untuk Orang Tua Isteri"]