JADUAL PERTAMA - Borang 16 (KAEDAH-KAEDAH UNDANG-UNDANG KELUARGA ISLAM (BORANG DAN FI) 2003

M.P.U. 20/2003
KAEDAH-KAEDAH UNDANG-UNDANG KELUARGA ISLAM (BORANG DAN FI) 2003

JADUAL PERTAMA - Borang 16

ENAKMEN UNDANG-UNDANG KELUARGA ISLAM
(NEGERI MELAKA) 2002

(Seksyen 55)

PERAKUAN PERCERAIAN

Bilangan pendaftaran cerai: .....................................................................
Tarikh pendaftaran cerai: .........................................................................
Tarikh bercerai : ..................................... Tempat bercerai: ................................................ Bilangan pendaftaran perkahwinan/ruju’: ..................................................................................
Tarikh perkahwinan/ruju’ : ................................................................................
Nama suami: ................................................ No. Kad Pengenalan /Pasport: ................................. Umur: ............................... Pekerjaan: ............................................................................... Alamat suami: ............................................................ Nama isteri: ............................ No. Kad Pengenalan/ Pasport: ......................................................Umur: .............................. Pekerjaan: ........................................................... Alamat isteri: ........................................................
Nama saksi (1): ......................................................... No. Kad Pengenalan: ..........................
Nama saksi (2): ......................................................... No. Kad Pengenalan: ..........................
Cara Bercerai: .............................................................. Talaq kali: .......................................
Bayaran Tebus Talaq (jika ada): ............................................................................................
Cerai dalam keadaan suci/semasa haid/semasa mengandung: ..............................................
Nafkah dalam ‘Iddah: ............................................................................................................
Nafkah untuk anak: ................................................................................................................
Mut’ah: .................................................................................................................................
Penyelesaian harta dan sebagainya: .......................................................................................

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

.........................................................
(Nama dan Tandatangan Pendaftar)