P.U. (A) 143/87
KAEDAH-KAEDAH PERBICARAAN HAL EHWAL SUAMI ISTERI 1987
JADUAL - Borang 4.
AKTA UNDANG-UNDANG KELUARGA ISLAM
(WILAYAH PERSEKUTUAN) 1984
(Seksyen 54 (5))
SURAT PERAKUAN CERAI
No. .......................................................
No. Sijil Perakuan Nikah ...............................................
No. Permohonan Cerai .................................................
Nama suami .................................................................................................. No. Kad Pengenalan ....................................................................... Alamat .................................................................................................................................................... Umur ....................................... Pekerjaan ......................................................
Nama isteri .................................................................................................... No. Kad Pengenalan ....................................................................... Alamat.................................................................. .................................................................................................................................................... Umur ....................................... Pekerjaan.....................................................................................
Tarikh perkahwinan H/M .................................................................................................................
Nama saksi (1).................................................................. No. Kad Pengenalan..............................
Nama saksi (2).................................................................. No. Kad Pengenalan..............................
Cara bercerai ...................................................................... Talaq kali ...........................................
Bayaran tebus talaq (jika ada) ........................................................................................................
Tempat bercerai............................................................................. Tarikh bercerai H/M...................
Cerai dalam suci/haidh/mengandung*..................................................................................................................
Nafkah dalam 'iddah .......................................................................................................................
Nafkah anak ..................................................................................................................................
Mut'ah ..........................................................................................................................................
Penyelesaian harta, dsb .................................................................................................................
Tarikh: H/M ............................................
........................................................
Tandatangan Ketua Pendaftar
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* Potong mana yang tidak berkenaan.
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