JADUAL PERTAMA - BORANG 12 (KAEDAH-KAEDAH UNDANG-UNDANG KELUARGA ISLAM (BORANG-BORANG DAN FEE) 1988

N.S. P.U. 19/88
KAEDAH-KAEDAH UNDANG-UNDANG KELUARGA ISLAM (BORANG-BORANG DAN FEE) 1988

JADUAL PERTAMA - BORANG 12

BORANG 12

(Seksyen 53)

PERAKUAN ANGGAPAN KEMATIAN

Di hadapan ...............................................
......................................................................
(Nama Hakim Syariah)

Hakim Syariah,
......................................................................
......................................................................

SETELAH mendengar permohonan dari........................................................................ No. Kad Pengenalan/Passport ...................................................................... beralamat di ..............................................................................................dan saksi-saksinya, iaitu ................................................................................. No. Kad Pengenalan/Passport ...................................................................... beralamat di ........................................................................................................ dan ................................................................................. No. Kad Pengenalan/Passport ...................................................................... beralamat di ........................................................................................................

SAYA MEMPERAKUKAN bahawa, bagi tujuan-tujuan seksyen 53 Enakmen undang-undang Keluarga Islam (Negeri Sembilan) 1983 .............................................................................................. (Nama) No. Kad Pengenalan/Passport ........................................................... yang mana alamatnya yang terakhir ialah di ............................................................................ dengan ini dianggap mati.

(METERI)

Tarikh.....................................

......................................................
(Tandatangan Hakim Syariah)

...............................................
(Nama)