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 .........................................................................................................................
.......................................................................................................................................................
(Meteri)
........................................
Tandatangan Pendaftar
.........................................
Tandatangan Perempuan
....................................................
Tandatangan Laki-laki
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