Mediation / Counselling Application - Shariah Advisory

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Quranic verse

"Then, there is no sin on them in entering into a compromise between them. Compromise is better. Avarice is made to be present in human souls. If you do good and fear Allah, then, Allah is All-Aware of what you do."[C-4:V-128]

1 Husband & Wife
2 Separation & Children

Applicant's Details (Wife)

Full Name

Date of Birth

Nationality

Current Status

Occupation

Contact Number

Email

Address

Husband's Details (To whom you would like to issue the divorce)

Full Name

Date of Birth

Nationality

Current Status

Occupation

Contact Number

Email

Have you been issued Talaaq before? (If Yes Give Details)

Address

Do you have a civil marriage?

Upload Marriage Certificate (if any)

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Separation Details

Date of Separation

Are you and your spouse still sharing the same residence?

Have any Counselling sessions been attended previously?

If yes, how many sessions were attended?

Was a third-party (family, scholar, or counselor) involved in reconciliation?

If yes, what was their advice or decision?

Are both parties open to attending further Counselling?

Please describe any efforts made to resolve the issues before seeking Khul'ah

Any additional comments or context that may help the mediator/counselor

Is there a restraining order?

Dispute Details

Children's Details

Are there any children?

Upload ID Proof (Optional)

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Note: Inaccurate information could lead to delays or your application being rejected.