Form 15 (ISLAMIC FAMILY LAW (FORMS AND FEES) RULES 2003

M.P.U. 20/2003
ISLAMIC FAMILY LAW (FORMS AND FEES) RULES 2003

Form 15

(Section 54)

CERTIFICATE OF PRESUMPTION OF DEATH

BEFORE TUAN ....................................................................................................................
SYARIAH JUDGE

This is to certify that the person mentioned below is presumed dead:

Full name: ..............................................................................................................................
Identity Card/Passport No.: ........................................................... Sex: ................................
Last address: ..........................................................................................................................
Cause of death: ......................................................................................................................
Place of death: .......................................................................................................................

Witnesses certifying:

(1) .......................................................... Identity Card No:. .........................................

(2) .......................................................... Identity Card No:. .........................................

Circumstances of death: .........................................................................................................

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

.........................
(Syariah Judge)

(Seal)