Form 4 (MARRIAGE AND DIVORCE (FEES AND FORMS) RULES 2003

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

Form 4

(Section 22)
PARTICULAR TO BE ENTERED INTO MARRIAGE REGISTER

1. No.:......................... Date of solemnization of marriage (A.H): ............................... date of marriage (A.D): ..................................................... Time:.........................

2. Place of solemnization of marriage:.......................................................................... Mukim Masjid:................................. District: .....................................................

3. Name of Bridegroom:........................................................................................... Identity Card/Passport No:............................ Age:................ Race: ...................... Occupation: ................................... Nationality: .................................................. Address: .............................................................................................................................................................................................................................................

4. Name of Bride: .................................................................................................... Identity Card/Passport No:...........................Age: ...............Race: ..................... Occupation:.................................. Nationality:.................................................... Address : ...........................................................................................................................................................................................................................................

5 No. of Wife .........................

6. The bride is an anak dara/janda/balu*, completed the iddah period by three quru’/three months/delivery/four months ten days* and the last husband does not ruju’ her and there are no disqualifications for her marriage and her certificate of Divorce No................................................................../certificate of Death No......................./Certificate of Presumption of Death No. ..................... issued by the Registrar ................................................................................

7. Name of Wali/Wali Hakim: ........................................................................... Identity Card No./Passport No.: ........................... Age: ............. Race: .................... Relationship : ...................................... Nationality:............................................ Address: .............................................................................................................................................................................................................................................

8. Name of Witness of solemnization of Marriage (1): ............................................ Identity Card No.:.................................................................................................... Signature: .............................................................................................................. Name of Witness of solemnization of Marriage (2):.............................................. Identity Card No.:.................................................................................................... Signature:.............................................................................................................

9. Name of Jurunikah:.................................................................................................... Identity Card No: ................................................... Age : ..................................... Occupation:......................... Address: ....................................................................................................................................................................................................

10. Mas kahwin: ................................ cash/credit:..................................................

11. Other pemberian:....................................................................................................

12. Declaration of consent of the bride:

I (name of bride) ..................................................................................................... do hereby give consent to (state name of Wali and relationship to the bride) .................................................................................................................................................................................. to marry me to (name of bridegroom) ...............................................................................................with the mas kahwin of RM ........................................................................................................................

..............................................
(Signature of Bride)

13. Declaration of Wali:

I (name of Wali Nasab/Wali Hakim*)................................................................... do hereby give permission to (name of representative) ..................................... to act as my representative to solemnise the marriage of (state name of bride and relationship to the Wali) ............................................................................... to (name of bridegroom) .................................................................................... with the mas kahwin of RM................................................................... and I do hereby solemnly affirm that the bride is not disqualified under Hukum Syarak to be married.

................................................................
(Signature of Wali Nasab/Wali Hakim*)

14. Declaration of Ta’liq:

I (name of husband) ............................................................................................. hereby make 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 where as 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 Court and if it is found by the Syariah Court to be true, and she gives to the Syariah Court which received on my behalf a sum of one ringgit, then she is divorced by a talaq khul’i.

..............................................................
(Signature of Bridegroom who read the Ta’liq)

15. Registrar’s Remarks:

I do solemnly declare that all the particulars contained in this Form are true as given by the persons stated herein and I am satisfied with all the particulars, therefore the marriage is solemnised.

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

..............................................
(Signature of Registrar)

(*) Delete whichever is not necessary.