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




Tarikh .............................................
...................................
Tandatangan Pendaftar




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