Center for Islamic Counseling and Guidance

To Download the Marriage Junction form Click Here

Wali Form

Name (before accepting islam):
Name (after accepting islam):
Address:
Email:
Age:
Ethnic Origin:
Place of Birth:
How long have you been Muslim:
Which Masjid do you attend:
Would you provide your ssn# for background check if asked to?:
If no why?:
Would you be willing to take an HIV test (recommended)?:
if no why?:
Have you ever been married:
If yes how many times?:
have you ever ended a marriage relationship before?:
If yes how many marriages have you ended and how long the marriage lasted?:
Would you mind furnishing information of your previous wife's phone number or her wali?:
If no why?:
Have you been told that you have a temper?:
if yes please explain?:
have you ever beaten your wife?:
If yes please explain the incident(s):
Do have a job or a source of income :
if yes what is your annual salary range:
Do you have another family:
Do you have kids?:
When do you plan to marry?:
What is your Educational Background:
Additional Comments:
Terms of Agreement:	Since this information is gathered or obtained to establish a very important aspects of our faith, which is marriage. Any false information can be considered as a breech of the marriage contract. Therefore I swear by Allah (SWT) that all the information is accurate to the best of my knowledge.
I hereby agree to the following terms: