Name *

First Name

Last Name

Phone *

Country

(###)

###

####

Groom's Name *

First Name

Last Name

Groom's Date of Birth *

MM

DD

YYYY

Groom's Phone

Country

(###)

###

####

Groom Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Is groom a UK resident? *

Yes

No

Groom's Islamic Status *

Born Muslim

Convert / Revert

Non Muslim

Bride's Name *

First Name

Last Name

Bride's Date of Birth *

MM

DD

YYYY

Bride's Phone

Country

(###)

###

####

Bride's Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Is bride a UK resident? *

Yes

No

Bride's Islamic Status *

Born Muslim

Convert / Revert

Non Muslim

Was the bride previously married? If yes, please provide proof of divorce. *

Yes

No

Does the bride have a Wali (guardian)? If yes, please provide Wali details *

Yes

No

Wali's Name

First Name

Last Name

Wali's Date of Birth

MM

DD

YYYY

Wali's Phone

Country

(###)

###

####

Wali's Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Wali's Islamic Status

Muslim

Non Muslim

Do you have a witness 1? If yes, please provide witness details *

Yes

No

Witness 1 Name

First Name

Last Name

Witness 1 Date of Birth

MM

DD

YYYY

Witness 1 Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Witness 1 Islamic Status

Muslim

Non Muslim

Do you have a witness 2? If yes, please provide witness details *

Yes

No

Witness 2 Name

First Name

Last Name

Witness 2 Date of Birth

MM

DD

YYYY

Witness 2 Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Witness 2 Islamic Status

Muslim

Non Muslim