THE LONDON CENTRAL MOSQUE TRUST & THE ISLAMIC CULTURAL CENTRE A Registered Charity. 146 Park Road, London NW8 7RG. Tel: 020 7724 3363 (10 Lines). Fax: 020 7724 0493 Website: http://www.iccuk.org Email: info@iccuk.org
Islamic Divorce Booking Form
Date Time
Details
Surname (Last Name) First Name Date of Birth Telephone Address UK
Husband
Wife
Overseas
UK Resident? Nationality Passport Number Born Muslim?
Yes
No
Yes
No
Yes
No (Embraced)
Yes
No (Embraced)
Islamic Marriage Certificate (Nikah) Details
Mosque/Center and Country Certificate Number Date of Islamic Marriage
Names of the Two Muslim Male Witnesses 1st Witness Which divorce is this? First Second 2nd Witness
Third
Official Use Only Submitted Supporting Documents Islamic Marriage (Nikah) Certificate Processing Fees Date Name of ICC Imam Amount Husband’s Passport Wife’s Passport
Cheque No. Receipt No. Islamic Divorce Certificate No.