Application for an Islamic divorce (Talaq):

Husband's information

Husband's information > Contact information

Husband's information > Date of birth:

Husband's information > Names of Father and Mother

Husband's information > Religious and sect

Wife's information

Wife's information > Contact information:

Wife's information > Date of birth:

Wife's information > Names of Father and Mother:

Wife's information > Religious and sect

Date of marriage (AQD NIKAH)

who is applying for the divorce? Divorce Applicant? Husband and wife (joint Application) Husband wife

After you get married have you ever had intercourse with your partner (wife or Husband)?

> Intercourse Yes No

Is the wife pregnant? Pregnancy? Yes No

The menstrual cycle (period) status The optoins are:

1-Currently I am not in in menstrual and since last menstrual there was no sexual intercourse .

2- Currently I am in menstrual or Lochia (nifas).

3- Postmenopausal.

Menstrual Not in menstrual Currently in menstrual Postmenopausal

Divorce count Divorce count? First Second Third

Divorce Kind Divorce Kind Revocable (Rajee) Or irrevocable for postmenopausal Irrevocable (khala) Irrevocable (Mobarat)

Does the wife you hate (averse) her husband?

If yes, is the aversion to the husband at high level that she threat not to fulfilling the marital duties.

The hatred is not the result of harming of husband or mistreatment?

Do you hate your husband? Yes for all above No
Amount offered The Wife offer all her Mahr (Dowry) The Wife offer some of her Mahr (Dowry) The Wife offer something else

Amount?

.

What is the Mahr (Dowry)? what is the reccived amount? what is the forgiven amount?

Applicant/s: I / we hereby authorize Sayed Alawi and authorize him to delegate another person to conduct our divorce (talaq). I / we is / are making this declaration of our / my own free will and we declare that we gave all information by our self and we believe that the statements in this declaration are true in every particular.

Submit