Pg. P.U. 5/2000
MARRIAGE, DIVORCE AND RUJU' (STATE OF PENANG)
RULES 2000
FIRST SCHEDULE (Form 1)
FORM I
(Rule 3)
APPLICATION TO MARR Y FOR MALE
A. PARTICULARS OF APPLICANT (MALE)
1. Name . …………………………………………………………………………………
2. I.C/Passport No ………………………….3. Date of Birth . ……………………….
4. Address . ………………………………………………………………………………
5. Race ………………………………………6. Nationality . ………………………….
7. Qualification ……………………………..8. Occupation …………………………...
9. Income 10. …………… Date of Conversion to Islam (ifany) ……………………..
11. Tel.No.: ………………………………………………………………………………
B. PARTICULARS OF BRIDE
I. Name . …………………………………………………………………………………
2. I.C/Passport No ………………………..3. Date of Birth . ………………………..
4. Address ……………………………………………………………………………….
5. Race …………………………………..... 6. Nationality …………………………..
7. Qualification …………………………… 8. Occupation ………………………….
9. Income . …….............. 10. Date of Conversion to Islam (if any) ………………
11. 'Tel. No.: . …………………………………………………………………………..
C. PARTICULARS OF MARRIAGE
1. Proposed date of marriage . ……………………………………………………….
2. Address ………………………………………………………………………………
D. AFFIRMATION OF APPLICANT
1. I do hereby solemnly affirm that I am still *bachelor/widower/divorced/married.
2. Divorce Certificate No. (if divorced) ………………………………………………..
3. I do hereby solemnly affirm that all the above particulars are true and if any of the particulars is false I have committed an offence punishable under section 38 of the Islamic Family Law (State of Penang) Enactment 1985.
Date: . ………………………………..………………………………………..
Signature of Applicant
E. *AFFIRMATION OF WITNESS ("JAWATANKUASA KARIAH" "PEGAWAI MASJID"/ISLAMIC AFFAIRS OFFICER) (For Muallaf Only) OR EMBASSY (Non Malaysian Citizen)
1. Affirmation by two witnesses ("Jawatankuasa Kariah"/"Pegawai Masjid"/Islamic Affairs Officer) that all the particulars in this form are true.
1.1 Witness 1
Name ......................................... I/C. No. ....................................................................
Address ........................................................................................................................
Date ........................................... Signature/Stamp ...................................................
1.2 Witness 2
Name ......................................... I/C. No. ....................................................................
Address ........................................................................................................................
Date ........................................... Signature/Stamp ...................................................
Affirmation by Embassy of ................................................................ that all particulars in this form are true and that there is no restriction for the applicant to get married
in Malaysia.
Date: . ………………………………..………………………………………..
Signature and Official Stamp
F. STATEMENT BY ASSISTANT REGISTRAR
(except for non-citizen)
..................................................................................................................................................
..................................................................................................................................................
Date: . ………………………………..………………………………………..
Signature and Official Stamp
FOR OFFICE USE
This application is ............................................. Approved/Not Approved
Date: . ………………………………..………………………………………..
Signature of Registrar
*Delete whichever is flot applicable.
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