I, ___________________________, husband, to  ___________________________, wife, swear, that I declared the

Divorce from her in proper Islamic manner on ___________[number] Day of ______________

[month],____________ [year], at approximately ___________ [time, a/m or pm]  more than ninety days ago, have

done nothing to break the iddah, have not taken her back and she is not pregnant.  This Affidavit is submitted in

support of my application for issuance of a National Muslim Divorce Certificate.

I swear by Allah, azza wa jal, author of  the glorious Qur'an and Lord of the Worlds, four times in the name of
Allah that I am truthful and  invoke curse for the fifth time saying: Let there be curse of Allah upon me if I
deliberately lie, and I invite the curse of Allah, azza wa jal, upon me and invite that I be punished, if I exaggerate
the facts in this matter, and further swear by Allah, Most High, that what I state here is true to the best of my
information and belief, and I hereafter submit this Notarized Affidavit, notarized by a person authorized by the
state I live in, to take oaths and verify my identify, in support of my Application for issuance of a National
Muslim Divorce Certificate from Muslim Vital Records International issued on fine parchment with raised seal
and signature of authenticity.

I  believe in Allah, Most High, Lord of the Worlds, and I witness that Muhammad [P] is the final Messenger of  
Allah.                                                                               

Signature:..........................................          

Notary Signature  .........................................


Note: This Affidavit MUST be NOTARIZED and signed

Narrated Abdullah: The Prophet said, "Whoever has to take an oath should swear by Allah or remain silent." (i.e. He
should not swear by other than Allah.)  Book #48, Hadith #844, Sahih Bukhari


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