Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. – Step 1 of 2PLEASE NOTE THIS APPLICATION MUST ONLY BE COMPLETED IF YOU ARE 100% CERTAIN THE MARRIAGE IS BEYOND RECONCILIATION Part 1 Personal Informationa) The Applicant (You)I HAVE TRIED EVERY AVENUE TO SAVE THE MARRIAGE BUT FAILED *Yes I am ready to proceed with this application (please do not complete this form if you are not ready to apply today)How did you hear about us ? *I Google SearchedRecommendedOtherPlease confirm that you are happy to pay the non refundable fee today *£265 One off paymentThe fee is the total amount that you will pay and the process takes 3 months maximum(Wifes) Applicants Surname *(Wifes) Applicants First Name *Father’s full name *(Wifes) Applicants Address *(Wifes) Applicants Town *(Wifes) Applicants Postcode *My address is strictly confidential and is not known to the respondent (husband) *YesNoApplicants Telephone *Landline telephone number(Wifes) Applicants Email *Mobile telephone *Date of Birth *DD12345678910111213141516171819202122232425262728293031MM123456789101112YYYY202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Nationality *Your Occupation *b) Respondent (Your Spouse)Husbands Surname *Husbands First Name *Husbands Father’s full name *Husbands Full Address *Husbands Town *Husbands Full Post Code *Husbands Telephone *Landline telephone numberHusbands Email *Husbands Mobile telephone *Date of Birth *DD12345678910111213141516171819202122232425262728293031MM123456789101112YYYY202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Place of Birth *Nationality *Husbands Occupation *NextPart 2: Details of MarriageDate of Marriage *DD12345678910111213141516171819202122232425262728293031MM123456789101112YYYY202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Place of Marriage *A copy of the marriage certificate (nikah nama) from the Masjid and/or Civil Registration if available Click or drag a file to this area to upload. In the absence of the marriage certificate, please contact the officePart 3: Your IdentificationPlease upload a copy of your Photo ID i.e Passport or Driving Licence Click or drag a file to this area to upload. Please upload a copy of your benefits proof if you have it Click or drag a file to this area to upload. Part 4: Other ProceedingsAre any court proceedings in relation to your marriage currently ongoing? *YesNo(If Yes, please give details)Is there a restraining/non-molestation order in place? *YesNoIf Yes, provide a copy of the order Click or drag a file to this area to upload. Files allowed : jpg,png,jpeg,bmp,doc,pdf,txt,pptHas your marriage been dissolved by a UK court? *YesNoIf Yes, provide a copy of the order Click or drag a file to this area to upload. Files allowed : jpg,png,jpeg,bmp,doc,pdf,txt,pptHave any third-party organisations or agencies such as police, social services, home office etc. ever been involved in your marital disputes or problems? *YesNo(If Yes, please provide brief details below) Part 5: Particulars of Marriagea) Residence1. Are the spouses living separately? *YesNo3. Would you like to share the brief reason(s) for the current separation? Please remember this is not compulsory at this stageb) Reconciliation/Mediation1. Have any attempts for mediation or reconciliation been made? *YesNo(Continue to question 2 if you answered Yes, otherwise go to question 3)2. What was the outcome of the reconciliation attempt(s)?3. Do you wish The Sharia Council to attempt a reconciliation? *YesNo(If Yes, on what terms?)Part 6 Checklist: CHECKLISTProof of Identification (valid passport, UK driving licence)Documents/Statements from organizations (if applicable)Copy of restraining/non-molestation order (if applicable)Copy of The Islamic marriage certificate (Nikah Nama)Non Refundable Fee of £265.00Copy of Decree Nisi/Absolute/Final Notice (if applicable)The fee is £425.00 online Non Refundable this covers 2 Mediation Meetings if agreed and complete process required including issuing the Khulla Notification – Certificate to the applicant. Once you submit this form you will need to make a payment at the next stage before we can accept this application. Once application has been submitted and fees paid a refund cannot be issued if you decide to cancel the application at any time during the processSignature of Applicant *By pressing submit I confirm that I have read and understood the terms and conditions above and agree to the following: I testify in the name of Allah (subhanahu wa ta’ala سبØانه وتعالى) that all the information I have provided is true and complete to the best of my knowledge. I understand and agree to The Shariah Council’s ‘Code of Practice’ and policies, and authorise The Shariah Council to process and decide the matter of my Islamic divorce only in accordance with Islamic Law. I understand that any false or misleading information may affect the validity of the decision taken by The Shariah Council and may lead to the termination of my application. NO REFUND WILL BE ISSUED IF THE APPLICATION HAS BEEN TERMINATED DUE TO MISSLEADING INFORMATION Date *DD12345678910111213141516171819202122232425262728293031MM123456789101112YYYY202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Enter card details below *CardName on CardNameSubmit
