JADUAL PERTAMA - BORANG 17 (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 17

BORANG 17

(Seksyen 52)

PERMOHONAN UNTUK FASAKH
(No. ....................)

Kepada Pendaftar Mahkamah Syariah,
......................................................................
......................................................................
......................................................................

1. Saya, ................................................................................... No. Kad Pengenalan/Passport ........................................ Tarikh lahir ............................................ Alamat ............................................................................. Pekerjaan ............................................................................... Pendapatan sebulan ............................. memohon satu perintah untuk fasakh dengan suami saya bernama ......................................... ................................................................................... No. Kad Pengenalan/Passport .......................................... Tarikh lahir .............................. Alamat ........................................................................................................................................ Pekerjaan ................................................................. Pendapatan sebulan .............................

2. Alasan-alasan permohonan:
........................................................................................................................
.........................................................................................................................
.........................................................................................................................
........................................................................................................................

3. (1) No. Sijil Nikah/No. Pendaftaran perkahwinan*
..........................................................................................................

(2) Tempat berkahwin .......................................................................

4. Kami mempunyai ......................... orang anak:

Bil.	Nama	No. Kad Pengenalan/Passport*	Tarikh lahir	Jantina
(1)
(2)
(3)
(4)
(5)

5. (1) Kami telah/belum pernah bercerai/rujuk* pada ................................
(2) Talaq yang ke ..................................

6. Nyatakan harta sepencarian yang hendak dituntut oleh/diberi* kepada isteri/suami* ...............................................................................
..............................................................................
..............................................................................

7. Cadangan tentang pemeliharaan dan penjagaan anak-anak.
.....................................................................................................................
.....................................................................................................................
.....................................................................................................................

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

.............................................
(Tandatangan Pemohon)

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*Potong mana yang tidak berkenaan