Form 1. (THE ADMINISTRATION OF SYARIAH LAW WORK PROCEDURE MANNUAL, DEPARTMENT OF ISLAMIC FOR PERLIS (PROCEDURE AND FORM 1995)

Ps. P.U. 6/95
THE ADMINISTRATION OF SYARIAH LAW WORK PROCEDURE MANNUAL, DEPARTMENT OF ISLAMIC FOR PERLIS (PROCEDURE AND FORM 1995)

Form 1.

(JAIPs. 1)

DEPARTMENT OF ISLAMIC AFFAIRS STATE OF PERLIS
(THE ADMINISTRATION OF SYARIAH LAW DIVISION) 01000 KANGAR

Ref. No: .......................

APPLICATION FOR DIVORCE
Husband/Wife Declaration

Husband's name: ...................................................... bin .....................................................
NRIC No.: ........................................................ Age: ...........................................................
Occupation: .................................................... Income: .......................................................
Address: .............................................................................................................................

Wife's name: ........................................................ binti .......................................................
NRIC No.: .......................................................... Age: ........................................................
Occupation: .................................................... Income: .......................................................
Address: .............................................................................................................................

We hereby declare that the particulars below are true:

(A) 1. We were married/reconcilied ....................................................................... at Pejabat Kadi ................................................... State ............................................................... vide certificate of marriage/reconciliation No .................................................................................

2. We hereby mutually apply for a divorce (Sulh).

3. Reason/s for application .........................................................................................................

4. We have filed a complaint with the Administration of Syariah Law Division on ............................... and have met .................................... times for purposes of effecting a reconciliation but have failed.

5. We have ........................ child/children.

	Name	Age

(a)	.............................................................................................	.............................
(b)	.............................................................................................	.............................
(c)	.............................................................................................	.............................
(d)	.............................................................................................	.............................
(e)	.............................................................................................	.............................

(B) Custody of child/children.

1. .............................................................. child/children to be in the custody of the wife.

2. .............................................................. child/children to be in the custody of the husband.

(C) Claims.

1. Maintenance for children ............................ a month for ...................... child/children in the custody of the wife.

2. Maintenance for wife under "eddah" ................................ a month/for the duration of "eddah".

3. "Mutaah" (compensation) .................................................................................................

4. Jointly owned assets.
(a) House ..........................................................................................................................
(b) Land ............................................................................................................................
(c) Furniture ......................................................................................................................
(d) Others .........................................................................................................................

5. Other claims (including debts)
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6. Agreement.
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We hereby declare that all the information above has been supplied by us voluntarily and without any force from any party.

Signature: ................................................		Signature: ......................................
Name: .....................................................		Name: ...........................................
(Husband)		(Wife)
Date: .......................................................		Date: .............................................

(STATEMENT BY CONSULTANT OFFICER)
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Date: .................................	Signature:: .............................
	(Name: .................................)