APPLICATION TO FILE FOR AN ISLAMIC DIVORCE (DISSOLUTION/KHULA/TALAQ) Please read carefully and complete all sections of the form in CAPITAL LETTERS, otherwise we shall return the form Husband’s Details 1) Name: 2) Address: Zip Code: Tel (Home): Cell: Email: 3) Date & Place of Birth: 4) Nationality & Status: Wife’s Details 1) Name: 2) Address: Zip Code: Tel (Home): Cell: Email: 3) Date & Place of Birth: 4) Nationality & Status: 5) Date & Place of Islamic Marriage: 6) Date & Place of Civil Registration in the USA: 7) Amount of Dower (Mahr) Agreed: a) How much has been paid: b) How much has deferred: 8) Have you received any Jewelry/ Land/ Money from your husband? YesNo Detailed Explanation: 9) Have you been married before? YesNo If yes, please provide proof of your previous Divorce Certificate. 10) Details of children from this marriage: Name Age 11) Date since complete separation from husband 12) Have you applied for Civil Divorce? YesNo If yes, please provide the date when the divorce was finalized: If the answer is no, please read section A, and if it applies to your situation, consult with your legal advisor. 13) Did your husband defend the divorce petition in court? YesNo If No, Send copy of D10 form. [Note: Marriages which take place abroad and, are recognized by the relevant law of the land, are recognized by the American law as a legal marriage.] EXPLAIN YOUR SITUATION IN AS MUCH DETAIL AS POSSIBLE BELOW If you have any other documentation or proof to support your claim, please bring it to the meeting DECLARATION When I click ‘Submit’, I testify in the name of Allah (SWT) that the information which has been given is true. Application Fee : $250.00 Please bring a check (payable to Islamic Sharia Council) or cash to the council meeting. We will contact you after you submit this application. Signature (type in your name)
