Paroki St.

Maria Ratu Rosari

Jln. Mulawarman No. 92A
Gianyar 80515 Bali - Indonesia
Tlp. 0361 - 943457, Email: sekretparokigianyar@gmail.com
Gereja Katolik St. Maria Ratu Rosari Website: www.parokisanmarigianyar.org
Gianyar

FORMULIR PENDAFTARAN
KURSUS PERSIAPAN PERKAWINAN (KPP)

PRIA

Nama : .................................................................................................................................
Tempat / Tanggal Lahir : .................................................................................................................................
Alamat KTP (lengkap) : .................................................................................................................................
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Alamat Domisili (lengkap) : .................................................................................................................................
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Agama : .................................................................................................................................
Paroki Asal (lengkap) : .................................................................................................................................
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No. Telepon : .................................................................................................................................
E-mail : .................................................................................................................................

WANITA

Nama : .................................................................................................................................
Tempat / Tanggal Lahir : .................................................................................................................................
Alamat KTP (lengkap) : .................................................................................................................................
.................................................................................................................................
Alamat Domisili (lengkap) : .................................................................................................................................
.................................................................................................................................
Agama : .................................................................................................................................
Paroki Asal (lengkap) : .................................................................................................................................
.................................................................................................................................
No. Telepon : .................................................................................................................................
E-mail : .................................................................................................................................

NB :
Harap memeriksa kembali data Anda sebelum dikembalikan kepada sekretariat paroki. Data ini akan
digunakan untuk penerbitan sertifikat KPP.
Pertanyaan atau informasi lainnya dapat menghubungi sekretariat paroki.