N.S. P.U. 19/88
KAEDAH-KAEDAH UNDANG-UNDANG KELUARGA ISLAM (BORANG-BORANG DAN FEE) 1988
JADUAL PERTAMA - BORANG 11
BORANG 11
(Seksyen 53)
PERMOHONAN UNTUK PERAKUAN ANGGAPAN KEMATIAN
(NO. ....................)
Kepada Pendaftar Mahkamah Syariah,
......................................................................
......................................................................
......................................................................
1. Saya, ............................................................................................ No. Kad Pengenalan/Passport .............................................................. Tarikh lahir ............................................ Alamat ...........................................................................................................................................
yang telah berkahwin dengan:............................................................................ (Nama)
No. Kad Pengenalan/Passport ..................................................................... Tarikh lahir ...................................................
Alamat ....................................................................................................................................
memohon perakuan anggapan kematian bagi suami saya
....................................................................................
2. Sebab-sebab permohonan saya adalah seperti berikut:
....................................................................................
....................................................................................
....................................................................................
....................................................................................
3. Saya sertakan bersama ini *Sijil Perkahwinan No./Pendaftaran Perkahwinan No. yang diakui sah ......................................................
4. Keterangan lain (jika ada):
....................................................................................
....................................................................................
....................................................................................
5. Saya mengaku bahawa keterangan dan butir-butir di atas adalah benar dan sempurna.
| Tarikh ....................................... | .............................................
(Tandatangan Pemohon) |
Di hadapan saya,
(METERI)
| Tarikh..................................... | ...............................................
(Tandatangan Pendaftar
Hakim Syariah/Majistret/
Pesuruhjaya sumpah*)
...............................................
(Nama) |
____________________________________________________________________
*Potong mana yang tidak berkenaan
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