Form 5 (MARRIAGE AND DIVORCE (FEES AND FORMS) RULES 2003

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

Form 5

(Section 26)
MARRIAGE CERTIFICATE

District: .................... Register No.: ...................... Wife No.: ............................................ Date of solemnization of marriage A.H / A.D: ..................................................................

Name of Bridegroom: ......................................................................................................... Age:...................... Identity Card/Passport No:.................................................................. Address: ......................................................................................................................

Name of Bride: .............................................................................................................. Age: ...................... Identity Card/Passport No:.................................................................. Address: .......................................................................................................................

Name of Wali: .............................................................................................................. Age: ..................... Identity Card No: ................................................................................. Address: ......................................................................................................................... Relationship: ................................................................................................................

Name of representative:............................................................................................... Occupation: ...................................................................................................................

Name of Witness: (1) ................................................................................................... Identity Card No: ............................................................................ Age:.................... Address: ....................................................................................................................... .....................................................................................................................................

Name of Witness: (2) ................................................................................................. Identity Card No: ....................................................................... Age:.................... Address: ....................................................................................................................... ...............................................................................................................................

Mas kahwin: .............................................. cash/credit: .............................................. Other pemberian (if any): ............................................................................................

Date of issues of registration A.H/A.M: ...............................

...........................................................
(Name and Signature of Registrar)

The Bridegroom has made a declaration of the ta’liq as follows:

I (name of husband) ............................................................................................... hereby made a declaration of ta’liq that whenever I leave my wife (name of wife) ........................................................ for a period of four months or more, whether voluntarily or with force; or if I or my representative do not give her maintenance for a period of four months or more whereas she is obedient to me; or if cause hurt to her person or her honour or her property, or and then she makes a complaint to the Syariah Judge and if it is found by the Syariah Court to be true, and she gives to the Syariah Judge which received on my behalf a sum of one ringgit, then she is divorced by a talaq khul’i.

(Seal)

............................................................................................
(Name and Signature of Registrar who confirms that the Bridegroom has read the Ta’liq)