ENAKMEN 1 TAHUN 1983
ENAKMEN KELUARGA ISLAM 1983
JADUAL KELIMA - BORANG 5E.
BORANG 5E
NEGERI KELANTAN
ENAKMEN KELUARGA ISLAM 1983
(
Seksyen 39
(5)
)
DAFTAR RUJUK
1. Bilangan daftar .......................................................
2. Tarikh daftar ...........................................................
3. Tarikh rujuk .................................................. Tarikh cerai ........................................................
Bilangan Daftar Cerai ..................................................
4. Tempat ............................... Mukim .................................. Jajahan..........................................
Negeri .......................................................................
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Orang yang dikehendaki
Nama
No. Kad Pengenalan
Umur
Bangsa
Pekerjaan
Alamat
______________________________________________________________________________________
6. Lelaki
______________________________________________________________________________________
7. Perempuan
______________________________________________________________________________________
8. Saksi (1)
______________________________________________________________________________________
Saksi (2)
______________________________________________________________________________________
9. Pendaftar yang membenarkan rujuk
_______________________________________________________________________________________
10. Lafaz rujuk ...............................................................................
11. Lain-lain kenyataan ...................................................................
(Meteri)
Tarikh .............................................
...................................
Tandatangan Pendaftar
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