BORANG 4 (KAEDAH KELUARGA ISLAM (BORANG DAN BAYARAN) 1983

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

BORANG 4

BORANG 4
NEGERI KEDAH
ENAKMEN KELUARGA ISLAM, 1979
DAFTAR PERNIKAHAN
(Seksyen 21)

Bil ........................................
Nama lelaki dan bin .....................................................................................................................
Tarikh lahir .........................................................................
No Kad Pengenalan ............................................................
Alamat ........................................................................................................................................
Nama perempuan dan binti ............................................................................................................
Taraf perkahwinan ...............................................................
Tarikh lahir .........................................................................
No Kad Pengenalan ............................................................
Alamat ..........................................................................................................................................
Nama wali .................................................. nisbah wali .................................................................
No Kad Pengenalan ............................................................
Alamat ..........................................................................................................................................
Nama orang mengakad ...................................... No. K/P ...............................................................
Pekerjaan .....................................................................................................................................
Nama penuh Saksi :
(1) .............................................................. No. K/P ....................................................................
(2) .............................................................. No. K/P ....................................................................
Banyak Maskahwin $ ................................................................................................ Tunai/tangguh.
Belanja ...........................................................................................................................................
Pemberian ......................................................................................................................................
Tarikh Nikah ............................................................................. kali yang .......................................
Bertarikh ................................................. 19 ..............
Bersamaan .............................................. 14 ..............
Bayaran $10.00
MOHOR

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

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

LAFAZ TAALIK

Apabila aku tinggalkan isteriku ..................................................... binti ..........................................
lebih daripada enam bulan dan kemudiannya dibuat pengaduan kepada Pendaftar Nikah dan apabila disabitkan pengaduannya, maka pada ketika itu tertalaklah ia dengan satu talak.