SPMC@NLB 171126DHe

IMPORTANT: Please ensure that the spelling of your name and NRIC/FIN/Passport number as well as
that of your partner is correct as it will appear on your certificate exactly as entered in this form.

Applicant's Information

Partner's Information

Name (as in IC) Name (as in IC)
Gender Gender
Citizenship Citizenship
NRIC/FIN/Passport Number

NRIC/FIN/Passport Number

Address Address
Postal Code Postal Code
Handphone No. Handphone No.
House phone No. House phone No.
Email (optional) Email (optional)
Date of Birth [DD/MM/YYYY] Date of Birth [DD/MM/YYYY]
Race Race
Academic Achievement Academic Achievement
Language Proficiency Language Proficiency
Occupation Occupation
Income Income
Marital Status Marital Status
Islamic Education Islamic Education
Prefer more emphasis on Prefer more emphasis on
Tentative Marriage Date [DD/MM/YY] (optional)
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