BORANG 13 (KAEDAH KELUARGA ISLAM (BORANG DAN BAYARAN) 1983

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

BORANG 13

BORANG 13
NEGERI KEDAH
ENAKMEN KELUARGA ISLAM, 1979
PERMOHONAN PERCERAIAN
(Seksyen 40)

Pendaftar,
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Inilah dimaklumkan bahawa suatu permohonan perceraian telah dimasukkan untuk didaftarkan :
1. Nama lelaki ...............................................................................................................................
2. No. Kad Pengenalan ..................................................................................................................
3. Alamat .....................................................................................................................................
4. Nama perempuan ......................................................................................................................
5. No. Kad Pengenalan ..................................................................................................................
6. Alamat .....................................................................................................................................
7. Lelaki teruna, pernah berkahwin dsb ............................................................................................
8. Anak dara, balu atau janda dsb ...................................................................................................

(sertakan keterangan)

9. Apa nisbah wali dengan perempuan itu ........................................................................................
10. Jumlah maskahwin....................................... tunai atau tangguh ................................................
11. Lain-lain perbelanjaan.....................................tunai atau tangguh ...............................................
12. Pemberian, jika ada ..................................................................................................................
13. Taalik, jika dilafaz .....................................................................................................................

(gunakan lampiran jika perlu)

14. Tempat pernikahan ..................................................... tarikh ........................ masa ...................
15. Pegawai yang mengakad ...........................................................................................................

(sebutkan jawatan pegawai yang mengakad dsb.)

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16. Nama saksi-saksi, Kad Pengenalan dan alamat -

16.1 ..............................................................................................................................................
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16.2...............................................................................................................................................
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16.3 ..............................................................................................................................................
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Bertarikh ...................................................... 19 ..................
Bersamaan ................................................... 14 ..................

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Pendaftar/Kadi

1. Bilangan anak-anak hasil pernikahan ini -
1.1 .................................................................................................................................................
1.2 .................................................................................................................................................
1.3 .................................................................................................................................................
2. Bidangkuasa Mahkamah ..............................................................................................................
3. Butir-butir dahulu mengenai perbalahan suami isteri
.......................................................................................................................................................
.......................................................................................................................................................
.......................................................................................................................................................
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4. Sebab minta cerai .......................................................................................................................
5. Langkah-langkah perdamaian .......................................................................................................
6. Lain-lain perkiraan -
6.1 nafkah isteri .............................................................................................................
6.2 nafkah anak .............................................................................................................
6.3 penjagaan kanak-kanak ............................................................................................
6.4 harta sepencarian .....................................................................................................
7. Lain-lain hal ...............................................................................................................................