Nikkah Application Form
Please ensure all details are filled in correctly as these are the details that will be printed on your final Marriage Certificate
At least 7 days notice is needed to conduct any Nikkah ceremonies
Application Date
-
Day
-
Month
Year
Date
Proposed Nikkah Date
*
-
Day
-
Month
Year
Date
Proposed Venue
*
Jamia Masjid Rizvia Brierley Hill - £500
Other Venue - £300
Groom's Details
Full Legal Name
*
First Name
Middle Name
Last Name
Date of Birth
*
-
Day
-
Month
Year
Place of Birth
*
Nationality
*
Religion
Ethnicity
Phone
*
-
Area Code
Phone Number
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postcode
Occupation/Job Title
*
Father's Name
*
First Name
Last Name
Mother's Name
*
First Name
Last Name
Previously married?
*
Yes
No
How many previous marriages?
Please provide the reason why the marriage ended? (Only the latest marriage)
When did it dissolved?
-
Day
-
Month
Year
Date
How was dissolved?
Required Supporting Documents
Document related to changing legal name
Browse Files
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of
Agreement
I confirm that all information in this document is accurate and true.
I allow this form to collect sensitive information.
Groom's Signature
Date Signed
-
Day
-
Month
Year
Date
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Bride's Details
Full Legal Name
*
First Name
Middle Name
Last Name
Date of Birth
*
-
Day
-
Month
Year
Date
Place of Birth
*
Nationality
*
Religion
*
Ethnicity
*
Phone
*
-
Area Code
Phone Number
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Post Code
Occupation/Job Title
*
Father's Name
*
First Name
Last Name
Mother's Name
*
First Name
Last Name
Previously married?
*
Yes
No
Name of Attorney, if appointed by the Bride
First Name
Last Name
Address of Attorney
Street Address
Street Address Line 2
City
State / Province
Post Code
How many previous marriages?
Please provide the reason why the marriage ended? (Only the latest marriage)
When did it dissolved?
-
Month
-
Day
Year
Date
How was dissolved?
Required Supporting Documents
Document related to changing legal name
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Agreement
I confirm that all information in this document is accurate and true.
I allow this form to collect sensitive information.
Bride's Signature
Date Signed
-
Month
-
Day
Year
Date
Back
Next
Save
Al-Mahr (Dowry)
Al-Mahr (Dowry) Amount £
*
*
Pay at Once
Deferred
1st Witness Details
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
2nd Witness Details
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Back
Next
Save
Document Upload
Groom's Proof of ID
*
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Groom's Proof of Address
*
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of
Bride's Proof of ID
*
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of
Bride's Proof of Address
*
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of
I confirm that all information in this document is accurate and true.
I allow this form to collect sensitive information.
Signature
*
Save
Continue
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