Divorce application

Islamic Divorce Application

Please complete the form below in full.

Applicant's Name *

Applicant's Address *

Applicant's Date of Birth *

Applicant's Mobile Number *

Spouse Name *

Spouse Address *

Spouse Date of Birth *

Spouse Mobile Number *

Have you discussed your intent to divorce?

Yes No

Are you happy to meet along with your spouse?

Yes No

Number of Children (from this spouse)

Name & Age of All Children (if applicable)

Date of Nikkah *

Who performed the Nikkah? *

What was the Mahr (dowry) paid at Nikkah? *

Has divorce already occurred?

Yes No

What is/were the reason(s) for divorce? *

Witness Name & Contact *

Application Sent!

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