Form 10 (MARRIAGE AND DIVORCE (FEES AND FORMS) RULES 2003

Kn. P.U. 29/2003
MARRIAGE AND DIVORCE (FEES AND FORMS) RULES 2003

Form 10

(Section 47)
APPLICATION FOR DIVORCE

No.: ............................................

1. To Syariah Judge ....................................................................................................

I ............................................................................................................................ (name of applicant) Identity Card No.: ................................................ .Age:....................................... Address:............................................................................................................... Occupation:........................................ Income per month:....................................... apply for a divorce from my wife/husband named........................................................................................................................................................................... (name of partner)
Identity Card No.: ................................................. Age:....................................... Occupation:.......................................................................................................... Income per month: ................................................................................................

2. Date of marriage: .........................No. of Marriage Registration: .............................. Place of marriage: ............................................................................................... ..............................................................................................................................

3. We have.................................................................................................. children:

(1) ..................................................... age ........................................ male/female*

(2) ..................................................... age ........................................ male/female*

(3) ..................................................... age ........................................ male/female*

(4) ..................................................... age ........................................ male/female*

(5) ..................................................... age ........................................ male/female*

4. We have/have not been divorced/ruju’ on................................................................ No. of talaq:..........................................................................................................

5. He/she* is my ........................................................................ wife / husband*.

6. Proceeding continuing in any other places in respect of the same marriage and application (if any): ................................................................................................ Court: ..................................................................................................................... Date it began: ........................................................................................................ Name of parties: .................................................................................................... Date of trial: ........................................................................................................... Stage of the proceeding: ............................................................................................

7. Reasons for divorce:

(a) ........................................................................................................................

(b) ........................................................................................................................

(c) ........................................................................................................................

8. Steps which have been taken for reconciliation (if any): ............................................

9. An agreement (if any) ............................................................................................

10. In the event of divorce. I am wiling to pay/I claim as follows:

(a) Maintenance during the period RM ....................... x ( ) months of iddah (per month) Total: RM .................................

(b) Maintanance of children (per month) RM ....................... x ( ) months Total: RM .......................................

(d) Mas kahwin (cash/credit) RM ..................................................

(e) Other payments (if any)

................................................... RM ...............................

TOTAL RM ..............................

11. State jointly earned property (harta sepencarian) to be claimed by/given to the wife/husband* ..........................................................................................................

12. Provision as to the care and custody of children ................................................. ..............................................................................................................................

13. Particulars of order pray for ................................................................................

Dated: H/M :.................................

.............................................
(Applicant’s Signature)

(*) Delete whichever is not necessary.