BORANG 6 (KAEDAH KELUARGA ISLAM (BORANG DAN BAYARAN) 1983

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

BORANG 6

BORANG 6
NEGERI KEDAH
ENAKMEN KELUARGA ISLAM, TAHUN 1979
DAFTAR RUJUK
(Seksyen 21)

Bil ..............................................
Nama lelaki dan bin .......................................................................................................................
Tarikh Lahir ..........................................................................................
No. Kad Pengenalan .............................................................................
Alamat ..........................................................................................................................................
Nama perempuan dan binti .............................................................................................................
Tarikh lahir ...........................................................................................
No. Kad Pengenalan .............................................................................
Alamat .........................................................................................................................................
Jumlah talak yang dicerai ...............................................................................................................
Nama penuh Saksi :

(1) ................................................................... No. K/P ..............................................................
(2) ................................................................... No. K/P ..............................................................

Rujuk di atas talak yang ...............................................................................................................
Tarikh rujuk ........................................................................................
$5.00
MOHOR
Bertarikh ...................................................... 19 .......................
Bersamaan ................................................... 14 .......................

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

Kariah ........................................... Mukim .............................. Daerah ........................................