Form 14 (MARRIAGE AND DIVORCE (FEES AND FORMS) RULES 2003

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

Form 14

(Section 54)
APPLICATION FOR PRESUMPTION OF DEATH

To,
Registrar,
Syariah Court
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1. I (Name of Applicant): ............................................................................................... Identity Card/Passport No.: ...................................................... Age: ...................... Date of birth: ........................................... Address: ................................................................................................................................................................................ was married to (name): .......................................................................................... Identity Card/Passport No: ................................................... Age: ....................... Date of birth: ......................................... Address: .............................................................................................................................................................................. apply for certificate of presumption of death of my husband .............................................................................................................................................................. (name)

2. The reasons for my application are as follows:

( ) Married.

( ) Claims of estate property.

( ) Claims of pension.

( ) Others (specify) ...............................................................................................................................

3. I enclosed herewith a Marriage Certificate No.: ...................................................

4. Others evidence (if any):
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5. I do hereby solemnly affirm that all evidence and above particulars are true.

Dated: A.H/A.D .................................

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(Applicant’s Signature)