BORANG 16 (KAEDAH KELUARGA ISLAM (BORANG DAN BAYARAN) 1983

K. P.U. 2/1984
KAEDAH KELUARGA ISLAM (BORANG DAN BAYARAN) 1983

BORANG 16

BORANG 16
NEGERI KEDAH
ENAKMEN KELUARGA ISLAM, 1979
KEBENARAN DAFTAR CERAI TAALIK, PERINTAH, DSB
(Seksyen 40)

Pendaftar,
.................................................................
.................................................................
.................................................................

Bahawasanya suatu perceraian telah berlaku* / telah diluluskan dan butir-butirnya adalah seperti berikut untuk didaftarkan :

Bil....................................................................................
Daerah ............................................................................................................................................
Nama lelaki ....................................................................................................................................
No. Kad Pengenalan .......................................................................................................................
Alamat ............................................................................................................................................
Nama perempuan ...........................................................................................................................
No. Kad Pengenalan .......................................................................................................................
Alamat ..........................................................................................................................................
Jenis perceraian .............................................................................................................................
Bilangan perceraian ........................................................................................................................
Bayaran yang dikenakan .................................................................................................................
Tarikh perceraian ............................................................................................................................
Pegawai yang menjalankan upacara ................................................................................................
Bilangan Daftar ..............................................................................................................................
Nama penuh Saksi :
(1) ...................................................................... No. K / P ..........................................................
(2) ...................................................................... No. K / P ..........................................................

BAYARAN

MOHOR

Bertarikh .............................................. 19 ..............
Bersamaan .......................................... 14 ..............

................................................
Pendaftar / Kadi

*Potong yang mana tidak berkenaan