Islamic Divorce Form

ISLAMIC DIVORCE FORM
Who is applying for the divorce?*

HusbandWife
Husband's Details
Name

First NameLast Name
Date of Birth

DayMonthYear
Nationality
Include all nationalities held
Address

Street Address

Street Address Line 2

CityState / Province

Post CodeCountry
Email
Preferred Number

Country CodePhone Number
Other Number

Country CodePhone Number
Wife's Details
Name

First NameLast Name
Date of Birth

DayMonthYear
Nationality
Include all nationalities held
Address

Street Address

Street Address Line 2

CityState / Province

Post Code
Email
Preferred Number

Country CodePhone Number
Other Number

Country CodePhone Number
Islamic Marriage (Nikah)
Date of Marriage

DayMonthYear
Date
Place of Marriage
City, Country
Mahr
Details as set out in marriage contract
Received in fullReceived in partNot receivedOther
Civil Marriage
Did you enter into a separate civil marriage?

YesNo - skip to next section
Date

DayMonthYear
Place
City, Country
Has either party petitioned for a civil divorce?

YesNo
Date of civil divorce if already obtained

DayMonthYear
Date
Children
Please include details of any children of the marriage
Name, gender, date of birth and nationality
Reason for Divorce
Have you/your spouse applied for an Islamic divorce elsewhere?
If yes, include details (where, whether ongoing or concluded)
Briefly describe the reasons for your application
Please include anything you consider relevant, if reconciliation has been attempted, if you both agree that a divorce is the next step
Documents
Documents required
File Upload

Cancelof
Please let us know if you are unable to provide any of these
Authorisation
I, the undersigned applicant, authorise MRS Consultants to review my divorce application in accordance with Islamic principles and ethics. I confirm that the information provided is accurate and to the best of my knowledge. MRS Consultants reserve the right to decline my application if the information is found to be incorrect. A non-refundable deposit is payable on submission of this application.
Applicant's Signature*

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Date*

DayMonthYear
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ISLAMIC DIVORCE FORM

Husband's Details

Wife's Details

Islamic Marriage (Nikah)

Civil Marriage

Children

Reason for Divorce

Documents

Authorisation