Machine Translated by Google

People's Democratic Republic of Algeria

The Ministry of the Interior, Local Authorities and Urban Planning:

………………………………………………………… ........
Directorate of Organization and Public Affairs
Department for the Movement of
Request an administrative license for a mixed marriage
Persons Office for the Mobility of Foreigners
Authorization request form
mixed marriage

I - (Algerian Party:

Name: ........................................... .................................................. …………………………………………………………………………………………………….

…………………………………………………………………………………………………… .................................................. .................................. : Prénom before: the Date et

delieu

naissance : ........ ……………………………………………………………………………………………… ................................: Birth and place date

Father’s name: ………………………………………………………………………………….. ……………………………………………………………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………… ……………………Born on: ………………………………………………………………………………………… ... / ............

B: .......................... Nationality: .... ........................................ Function : . ……………………………………………………………………………… ……………………Identification Card No.:

…………………………………………………………………………………… ................ ...... Issued by: .........................

…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….. .................................................. …………

.............................................. ...................... ................ .................................................

E-mail: ................................................. .................................................. …………………………:. mail-E

Numéro De Tel: .......................................................... .................................................. ...................: Telephone No.

Signature of the person concerned

II - (Foreign Party: Name:

…………………………………………………………………………… .................................................. ................................................ : Nom

……………………………………………………………………… .................................................. .................................................. Date et lieu de

naissance : ................................................. …………………………………………: Birth place and date

…………/……………………………………………………………………………………………………………………………………
Father’s name: ………………………………… Born on: .

………………………………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………….. ./…………………………………………………………………………………………………………………………

Nationality: …………………………………… Job: . …………………………………………………………………………………… …………………………………… Passport No.:

……………………… ............................ Muslim by: ............................ ………………………………………………………………………………… ......

on the date : ................./.........../............ Valid until: ………………………………………….. Muslim by: …………………………………………………………………

1 (Residence Card No.: ................................

……………………………………………………………… .............. on the date : ................./.........../....

……………………………………………………………………………………………………………………………………………………………… .... 2 ) Date of entry: ......... /......./........

Authorized

period........ .............................. ................. from .. .../...../........... to me ........./......../......... .. 3 ) Certificate of ability to marry No.: ……………., delivered by:
………………………………………………… ................................on the date:..../. .../............ the address : ................................ .................................................. ……………………………………
..............................................................................................

E-mail: ................................................................. ………………………………………………………………… …………………………:. mail-E

Numéro De Tel: .......................................................... ……………………………………………………………………………… ...................: Telephone No.

Signature of the person concerned

Done at: …………………………………………………………………………………………………………….. ......./..............

(1) Only for resident foreigners. (2)

Especially for non-resident foreigners.
(3) An extract from the diplomatic or consular representation of the foreign party, or a similar certificate that suffices the purpose for countries that do not iss