FIRST SCHEDULE (Form 11) (MARRIAGE, DIVORCE AND RUJU' (STATE OF PENANG)

Pg. P.U. 5/2000
MARRIAGE, DIVORCE AND RUJU' (STATE OF PENANG)
RULES 2000

FIRST SCHEDULE (Form 11)

FORM 11

(Rule 11)

APPLICATION FOR DIVORCE

No. ..........................................................

To the Registrar of Syariah Court

1. I ...........................................................................................................................................................................

I.C. No. ..................................................................................................... Age .....................................................

Address .................................................................................................................................................................

Occupation ........................................................................... Monthly income ..................................................

Apply to divorce my Wife/Husband* named ...................................................................................................

..................................................................................................................................................................................

I.C. No. ..................................................................................................... Age .....................................................

Address .................................................................................................................................................................

Occupation ........................................................................... Monthly income ..................................................

2. Date of marriage ............................................ Registration No. (if any) ...................................................

Place of marriage ................................................................................................................................................

Mode of marriage ................................................................................................................................................

3. We have ................................................ children.

(1) ............................................................................................ age ................................................ boy/girl*

(2) ............................................................................................ age ................................................ boy/girl*

(3) ............................................................................................ age ................................................ boy/girl*

(4) ............................................................................................ age ................................................ boy/girl*

(5) ............................................................................................ age ................................................ boy/girl*

4. We have/have not been divorce/ruju' * on ....................................................................................................

Number of talak ..................................................................

5. She/He* is my ..................................................................... Wife/husband*.

6. Current proceeding in any other places in respect of the same marriage and application (if any).

Court .......................................................................................................................................................................

Commencement date .........................................................................................................................................

Name of paties .....................................................................................................................................................

..................................................................................................................................................................................

Stage of proceeding ............................................................................................................................................

7. Reasons for divorce ........................................................................................................................................

8. Steps which have been taken for reconcilation (if any) .............................................................................

..................................................................................................................................................................................

9. Agreement (if any) ...........................................................................................................................................

.................................................................................................................................................................................

10. In the event the divorce is granted I am willing to pay/claim* as follows:

(1)	Maintenance during the period of eddah per month	RM.................. ( ) month;	total RM ...................
(2)	Maintenance for a children per month	RM.................. ( ) month;	total RM..................
(3)	Mut'ah RM .................		RM..................
(4)	Mas kahwin cash/credit per month RM .......................		RM..................
(5)	Other payment if any RM ......................		RM..................

11. State any jointly earned property to be given to/to be claimed by husband/wife* ...............................

12. Provision as to the care and custody of the children ...............................................................................

13. Particulars of order prayed for .......................................................................................................................

Date: ....................................................

...............................................................
Applicant's Signature

* Delete whichever is not applicable