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(Translation)

Registration Office
Particulars 1. Name 2. Identification No. 3. Date of Birth 4. Registration of Marriage Reg. Office Reg. No. Date 5. Signatures of applicants

Registration of Divorce Province


Male

Khor Ror.6

Female

6. Signatures of witnesses

1. .. 2. ..

7. Registration

Reg. No. Date/Month/Year Signature of registrar Time hrs.

Addendum