ENAKMEN 1 TAHUN 1983
ENAKMEN KELUARGA ISLAM 1983


JADUAL KELIMA - BORANG 5D.
BORANG 5D

NEGERI KELANTAN

ENAKMEN KELUARGA ISLAM 1983

(Seksyen 39 (1))

KETERANGAN RUJUK


Bilangan daftar cerai .................................................... Tarikh .....................................................

Nama suami ............................................ Nombor Kad Pengenalan .............................................

Umur ............................................................ Pekerjaan .............................................................

Nama isteri ............................................... Nombor Kad Pengenalan .............................................

Umur ............................................................ Pekerjaan ..............................................................

Alamat suami ...............................................................................................................................

Mukim .................................... Jajahan ........................................ Negeri .....................................

Alamat isteri ................................................................................................................................

Mukim ..................................... Jajahan ..................................... Negeri .......................................

Adalah saya ...................................................................................................... (Nama Pendaftar)

Mukim .................................................................... Jajahan ........................................................

membenarkan kepada ............................... alamat ........................................................................

merujuk akan isterinya nama .............................. alamat ................................................................

yang telah mendapat persetujuan dari isterinya dengan lafaz saya rujuk akan isteri saya nama .............

............................................................ kepada nikah saya yang dahulu

Bilangan Daftar Nikah ......................................................................................................................

Tarikh perkahwinan ............................................ Tarikh rujuk ..........................................................

Lain-lain kenyataan .........................................................................................................................

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

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Tandatangan Pendaftar
.........................................
Tandatangan Perempuan
....................................................
Tandatangan Laki-laki




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