JADUAL PERTAMA (KAEDAH-KAEDAH PERKAHWINAN, CERAI DAN RUJU' (BORANG DAN FEE) 1989

Sel. P.U. 12/89
KAEDAH-KAEDAH PERKAHWINAN, CERAI DAN RUJU' (BORANG DAN FEE) 1989

JADUAL PERTAMA

BORANG 5/FORM 5

(Seksyen/Section 51 (3))

SURAT PERAKUAN RUJU'

1. Bilangan Daftar Cerai ................................................................................................................

2. Tarikh H/M ...............................................................................................................................

3. Nama Suami ............................................................................................................................
No. Kad Pengenalan ................................................................. Tarikh Lahir .................................
Pekerjaan ....................................................................................................................................
Alamat Rumah .............................................................................................................................
Alamat Pejabat ............................................................................................................................

4. Nama Isteri ..............................................................................................................................
No. Kad Pengenalan ................................................................. Tarikh Lahir .................................
Pekerjaan ....................................................................................................................................
Alamat Rumah .............................................................................................................................
Alamat Pejabat ............................................................................................................................

Saya ...........................................................................................................................................

(Nama Pendaftar)

memperakui bahawa-

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

meruju' isterinya (Nama) .....................................................................................................

yang telah terdapat persetujuan dari isterinya dengan lafaz-

"Saya ruju' akan isteri saya (Nama) .....................................................................

kepada nikah saya yang dahulu ..........................................................................."

Bilangan Daftar Nikah .......................................

Tarikh Perkahwinan H/M .............................................. Tarikh ruju' H/M ............................

Lain-lain kenyataan ..........................................................................................................

No. Daftar Ruju' ............................................

Tarikh H/M .........................

....................................................
Tandatangan Pendaftar

....................................................
Tandatangan/Cap Jari Suami

....................................................
Tandatangan/Cap Jari Isteri