khulla-application - The Islamic Sharia Council

PLEASE NOTE THIS APPLICATION MUST ONLY BE COMPLETED IF YOU ARE 100% CERTAIN THE MARRIAGE IS BEYOND RECONCILIATION

Part 1 Personal Information

a) Applicant (You)

Applicants Surname *

Applicants First Name *

Father’s full name *

Applicants Mother’s full name *

Applicants Address *

Applicants Town *

Applicants Postcode *

My address is strictly confidential and is not known to the respondent (husband) *

Yes
No

Applicants Telephone *

Landline telephone number

Applicants Email *

Mobile telephone *

Date of Birth *//

Place of Birth *

Nationality *

Mother Tongue

Your Occupation *

Medical Conditions

b) Respondent (Your Spouse)

Husbands Surname *

Husbands First Name *

Husbands Father’s full name *

Husbands Mother’s full name *

Husbands Full Address *

Husbands Town *

Husbands Full Post Code *

Husbands Telephone *

Landline telephone number

Husbands Email *

Husbands Mobile telephone *

Other Forms of Contact

Date of Birth *//

Place of Birth *

Nationality *

Mother Tongue

Husbands Occupation *

Any Medical Conditions

Part 2: Details of Marriage

Date of Marriage *//

Place of Marriage *

Duration of Marriage Years *

Years

Duration of Marriage Months *

Months

A copy of the marriage certificate (nikah nama) from the Masjid and/or Civil Registration if available

In the absence of the marriage certificate, please contact the office

Part 3: Details of Previous Marriage (If Applicable)

Have you been married before: *

Yes
No

When did the marriage end? *

How did the marriage end? *

Husband gave talaq
Widowed
Other

If applicable, send a copy of the divorce document or proof confirming the termination of your previous marriage

Part 4: Details of Children (If Applicable)

Full Name

Gender

Male
Female

Age

Full Name

Gender

Male
Female

Age

Full Name

Gender

Male
Female

Age

Full Name

Gender

Male
Female

Age

Full Name

Gender

Male
Female

Age

b) Arrangement for Access to Children

Children are living with the mother
Children are living with the father
Children are with neither

Has an arrangement for child access been settled by the court?

Yes
No

If Yes, provide a copy of the order

Files allowed : jpg,png,jpeg,bmp,doc,pdf,txt,ppt

Part 5: Other Proceedings

Are any court proceedings in relation to your marriage currently ongoing? *

Yes
No

(If Yes, please give details)

Is there a restraining/non-molestation order in place? *

Yes
No

If Yes, provide a copy of the order

Files allowed : jpg,png,jpeg,bmp,doc,pdf,txt,ppt

Has your marriage been dissolved by a UK court? *

Yes
No

If Yes, provide a copy of the order

Files allowed : jpg,png,jpeg,bmp,doc,pdf,txt,ppt

Have any third-party organisations or agencies such as police, social services, home office etc. ever been involved in your marital disputes or problems? *

Yes
No

(If Yes, please provide brief details below)

Part 6: Particulars of Marriage

a) Residence

1. Are the spouses living separately? *

Yes
No

(If yes, answer questions 2 & 3; otherwise only answer 2)

2. If this is not the first time the spouses have been separated please state when the first separation was

3. Would you like to share the brief reason(s) for the current separation? Please remember this is not compulsory at this stage

b) Reconciliation/Mediation

1. Have any attempts for mediation or reconciliation been made? *

Yes
No

(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? *

Yes
No

(If Yes, on what terms?)

Part 7:

Please make sure that all the checklist has been completed below

CHECKLIST

Proof 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 £425 online
Copy of Decree Nisi/Absolute (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 process

PAYMENT METHODS *

£425
£325 if you are on benefits (Please email us proof of benefits)

Relevant payment can be made by pressing submit below once the application form has been completed, please do remember that we will request proof of benefits if the discounted fee is applied

Signature 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 سبحانه وتعالى) that all the information I have provided is true and complete to the best of my knowledge. I understand and agree to The Sharia Council’s ‘Code of Practice’ and policies, and authorise The Sharia Council to process and decide the matter of my Islamic divorce in accordance with Islamic Law. I understand that any false or misleading information may affect the validity of the decision taken by The Sharia 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 *//