M.P.U. 20/2003
ISLAMIC FAMILY LAW (FORMS AND FEES) RULES 2003
Form 5
(Section 26)
MARRIAGE CERTIFICATE
No. Register: ................................... Date of Registration (A.H) : ......................... (A.D): .......................................................................................................................
Name of Bridegroom: .............................................................................................. Age: ..................................... Identity Card/Passport No.: ...................................... Race: ...................................... Nationality: ............................................................. Address: .....................................................................................................................................................................................................................................................
Name of Bride: ........................................................................................................ Age: ...................................... Identity Card/Passport No.: ..................................... Race: ...................................... Nationality: ............................................................. Address: ...................................................................................................................
Name of Wali.: ......................................................................................................... Age: ...................................... Identity Card No.: .................................................... Address: ................................................................................................................... Relationship: ............................................................................................................
Witnesses to solemnization of marriage:
(1) Name of Witness: ....................................................................................... Identity Card No.: ...................................... Age: ...................................... Address: ...........................................................................................................................................................................................................................
(2) Name of Witness: ....................................................................................... Identity Card No.: ...................................... Age: ...................................... Address: ...........................................................................................................................................................................................................................
Mas kahwin: ................................................ cash / credit: ..................................... Belanja hantaran: ..................................................................................................... Other pemberian (if any): ..........................................................................................................................................................................................................................
Date of issue 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—
(a) whenever I leave my wife (name of wife) ......................................for a period of four months qamariah continuously or more, whether voluntarily or with force; or
(b) if I or my representative do not give her maintenance for a period of four months qamariah continuously or more whereas she is obedient to me; or
(c) if I cause hurt to her person or her honour or her property, or cause abuse or any darar syarie,
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 ten ringgit, then she is divorced by a talaq khulu’.
.................................................................
(Name and Signature of Registrar who confirms that the Bridegroom has read the Ta’liq)
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