Form 14 (ISLAMIC FAMILY LAW (FORMS AND FEES) RULES 2003

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

Form 14

(Section 54)

APPLICATION FOR CERTIFICATE OF 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:

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

4. Other evidence (if any)

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5. I do hereby solemnly affirm that all evidence and above particulars are true.

Before me,

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

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(Applicant’s Signature)

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

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(Signature of Registrar of Syariah Court/Syariah Judge)

(Seal)

................................
(Name of Registrar/Syariah Judge)