JADUAL - Borang 5. (KAEDAH-KAEDAH PERBICARAAN HAL EHWAL SUAMI ISTERI 1987

P.U. (A) 143/87
KAEDAH-KAEDAH PERBICARAAN HAL EHWAL SUAMI ISTERI 1987

JADUAL - Borang 5.

AKTA UNDANG-UNDANG KELUARGA ISLAM
(WILAYAH PERSEKUTUAN) 1984

(Seksyen 53)

PERMOHONAN PERAKUAN ANGGAPAN MATI (MAFQUD)

Kepada Pendaftar Mahkamah Syariah.

Saya,............................................................................................................................................. No. Kad Pengenalan ...................................................................... Umur ....................................... Alamat........................................................................................................................................... yang telah bernikah dengan: ................................................................................................ (Nama) No. Kad Pengenalan ................................................................... Umur ......................................... Alamat........................................................................................................................................... Bil. Surat Perakuan Nikah...................................................... Tarikh: H/M........................................ memohon satu perakuan anggapan mati (Mafqud) di atas suami saya ................................................ ..........................................................................................................................................(Nama)
Bersama ini disertakan salinan Surat Perakuan Nikah.
Alasan-Alasan permohonan adalah seperti berikut:
.....................................................................................................................................................
.....................................................................................................................................................

Tarikh: H/M ...................................................

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Tandatangan Pemohon