handiramy's Blog

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Surat Pernyataan Memeluk Agama Islam

on August 28, 2014

SURAT PERNYATAAN MEMELUK AGAMA ISLAM

Yang bertanda tangan di bawah ini :

N a m a :
Jenis Kelamin :
Tempat/Tgl. Lahir :
Kewarganegaraan :
Agama Sebelumnya :
Pekerjaan :
Alamat :

Dengan kesadaran serta keinsyafan sendiri dalam keadaan sehat jasmani dan rohani serta tanpa ada paksaan dari siapapun dan pihak manapun juga, pada hari ini Jum’at tanggal ……… saya menyatakan bahwa saya memeluk agama Islam dan saya akan tinggalan semua ajaran yang menyalahi/bertentangan dengan Ajaran Agama Islam.

Demikian Surat Pernyataan ini saya buat dengan sebenarnya, apabila pernyataan ini tidak benar maka saya bersedia di tuntut sesuai dengan Hukum yang berlaku.

Jakarta, ………………….
Yang Menyatakan

(Nama terang WNA)

Saksi:
1.

2.

 

=======================================================================

CONFESSION LETTER ADHERE TO ISLAM

I, hereby, state that :

My name is :
Sex :
Place and Date of Birth :
Passport number :
Visa Number :
Marital Status :
Nationality :
Previous Religion :
Occupation :
Address : 1. (Original country) :

2. (Indonesia) :

With the full heartedly in good health both physically and mentally and without any influence from any parties, as of today
I hereby, confess to Islam. This confession is based on sincerity and beyond any influences whatsoever. Therefore, I witness that “There is no God but Allah and Muhammad is the messenger of Allah”. As a Muslim, I will fully perform the Islamic teachings and law and I will reprimand myself from all the unlawful practices which are not allowed by Islam.

This statement is signed accordingly and if one reason or another is not in line with what I am performing, I will then be subject to the legal procedure and then be ready to the court.

Jakarta,
Signed by,

(Nama terang WNA)

Witnesses:

1.

2.

====================================================================

*** Ingat surat ditandatangani disertai dengan materai Rp6000,-.

*** SEMOGA BERMANFAAT *** ^_^

Source: Facebook Closed Group “Foreign Relationship Community / FRC”, posted by admin.

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