The Consistory of the __________________ Protestant Reformed Church of __________________ hereby certifies that ______________ are/is a member(s) of the above congregation and, as far as known to us, are/is sound in faith and upright in walk.
At _____________ request, we hereby transfer our brother/(and) sister to the __________________ Protestant Reformed Church of _______________, commending them/ him/her to your Christian fellowship and requesting the consistory to take them/him/her under their supervision and in all cases to serve them/him/her with Christian counsel.
Last Name: _______________ Phone No.: __________
Address: _______________________________________
| Given Name | Date of Birth | Date of Baptism | Date of Profession | |
|---|---|---|---|---|
| Single | ___________________________ | ___________________ | ___________________ | ___________________ |
| Husband | ___________________________ | ___________________ | ___________________ | ___________________ |
| Wife | ___________________________ | ___________________ | ___________________ | ___________________ |
| Children | ___________________________ | ___________________ | ___________________ | ___________________ |
| ___________________________ | ___________________ | ___________________ | ___________________ | |
| ___________________________ | ___________________ | ___________________ | ___________________ | |
| ___________________________ | ___________________ | ___________________ | ___________________ | |
| ___________________________ | ___________________ | ___________________ | ___________________ | |
| ___________________________ | ___________________ | ___________________ | ___________________ |
Done in consistory __________
_________________, President
_____________________, Clerk
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Membership Receipt
please return as soon as possible
The certificate of ___________________ from the _________________ Protestant Reformed Church has been duly received and accepted.
______________________, President
__________________________, Clerk
Dated ___________ Church: ______________________
Notice: The above-mentioned shall be considered still member(s) of the ____________ Protestant Reformed Church until this receipt is returned properly signed.
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The certificate of _______________________________ was sent to the ________________________ Protestant Reformed Church.
Date sent _______________________
Receipt returned _________________
(Cf. Acts of Synod, 1945, Arts. 40, 51; Acts of Synod, 1946, Arts. 17, 19; Acts of Synod, 2002, Art. 51.)