SWORN AFFIDAVIT for Muslim Divorce
Please copy this form and have it notarized and mail to
Muslim Vital Records
P.O. Box 305
Oaklyn. Jersey 08107
I, _______________________________ acknowledge Allah [SWT] as God and Prophet Muhammad [AS] as the final
[Your Name]
Messenger and I swear by Allah [SWT], four times and invite the wrath of Allah, [SWT], if I intentionally lie,
that I divorced _______________________________, and that I, being of sound mind and body, have declared the
[Sister Name]
divorce, on _____ Day of _______________, 2______.
My Muslim witness are: _________________________________ and _____________________________________
[name] [name]
and they may be contacted at ______________________________________________________________________
[Telephone #] [Telephone #]
and that I swear four times in the name of Allah that I am one of the truthful and invoked curse for the
fifth time saying: Let there be curse of Allah upon me if I am among the liars, and that I declared the Divorce
according to Islam [circle A, B, C, D or all below which apply]
A. On one occasion and have not been intimate with her in at least 90 days, since then, nor reconciled;
B. On two occasions and have not been intimate with her in at least 90 days, since then, nor reconciled;
C. On three separate occasions and at least 90 days has passed since my last declaration, or
D. She requested and I declared Kula'
Based on my sworn statement, inviting the wrath of Allah, [SWT], if I deliberately lie, I am requesting issuance of
a Muslim Certificate of Divorce this ______ Day of _____________________, 2__________.
.
I make this oath in front of a person authorized by my state to take a sworn statement from me, having verified
my identity. The stamp/seal of that person along with signature of verification is affixed to this sworn oath.
I do swear.___________________________________________
Sign Here
NOTARY: ____________________________