CB DATE APPLICATION TO FILE FOR A ISLAMIC DIVORCE (TALAQ) ver 1/11/10(Please read carefully and complete all sections of the form in capital letter, otherwise we shall return the form) Husband Details Wife Details 1. Name : 1. Name : 2. Address : 2. Address : Post Code Post Code Tel (Home) Mob Tel (Home) Mob E-Mail 3.Date & Place of Birth: 4.Nationality & Status :E-Mail 3.Date & Place of Birth: 4.Nationality & Status : 5. Date & Place of Nikah : 6. Date & Place of Registration in the UK: 7. Amount of Dower (Mahr) Agreed: a) How much has been paid b) How much has deferred 8. Have you given an y jewelery/ Land/ Money to your wife, please give d etails: 9. Main reason for asking Divorce: 10 . Have you been married before? Y es No If yes, please provide proof of your previous Divorce Certificate 11. Details of children from this marriage Name Age Name Age 12. Date Since separation from wife 13. Have you app lied for Civil Divorce? Yes/ No If yes, date of d ecree absolute, if appli cable: If no, please consult your solicitor: Note: Marriages which take place abroad and, are recognised by the relevant law of the land, are recognised by the English law as a legal marriage. DECLARATION I testify in the name of A llah (SWT) that the information which has been given is true. Signed: Dated: 34 Francis Road Leyton, London E10 6PW0208558 0581 0208925 0673 mycase@islamic- sharia.org www.islamic-sharia.o rg Opening times: Monday to Thursday 11am to 7pmPlease see reverse
