Muslim Divorce Questionnaire
Confidential Client Information Form
Please download and complete this questionnaire as accurately as possible. Click here.
All information provided will be treated as confidential and used solely for purposes of assessing your matter.
The form deals with the following:
1. Personal Details
Applicant Details
Full Name and Surname: ___________________________
ID / Passport Number: ___________________________
Date of Birth: ___________________________
Cell Number: ___________________________
Email Address: ___________________________
Residential Address: ______________________________________________
Spouse’s Details
Full Name and Surname: ___________________________
ID / Passport Number: ___________________________
Cell Number: ___________________________
Email Address (if known): ___________________________
Residential Address: ______________________________________________
2. Marriage Information
Date of Nikah (Islamic Marriage): ___________________________
Place where Nikah took place: ___________________________
Name of Imam / Marriage Officer (if known): ___________________________
Was a Nikah Certificate issued?
☐ Yes
☐ No
Do you have a copy of the Nikah Certificate?
☐ Yes
☐ No
Was the marriage also registered under South African civil law?
☐ Yes
☐ No
☐ Unsure
Which Islamic school of thought applies?
☐ Hanafi
☐ Shafi’i
☐ Maliki
☐ Hanbali
☐ Other: ___________________________
3. Current Marital Status
Are you:
☐ Husband
☐ Wife
Who is seeking the dissolution of the marriage?
☐ Husband
☐ Wife
☐ Both parties
Which form of Islamic divorce is sought?
☐ Talaq
☐ Khula
☐ Mubarat
☐ Faskh
☐ Unsure
4. Details of Separation
Are the parties currently living together?
☐ Yes
☐ No
If not, when did you separate?
Reason(s) for seeking divorce (brief summary):
5. Reconciliation Attempts
Have any attempts been made to reconcile the marriage?
☐ Yes
☐ No
If yes, please provide details:
☐ Family Intervention
☐ Mediation
☐ Religious Counselling
☐ Professional Counselling
☐ Other: ___________________________
Details:
6. Talaq Information (if applicable)
Has Talaq already been pronounced?
☐ Yes
☐ No
If yes:
Date of Talaq: ___________________________
How many Talaqs have been pronounced?
☐ One
☐ Two
☐ Three
Was the Talaq pronounced in writing?
☐ Yes
☐ No
Do you have proof or witnesses?
☐ Yes
☐ No
7. Khula Information (if applicable)
Has the wife requested Khula?
☐ Yes
☐ No
Has the husband agreed?
☐ Yes
☐ No
☐ Pending
Has any settlement regarding the Mahr been discussed?
☐ Yes
☐ No
Details:
8. Faskh Information (if applicable)
Please indicate any applicable grounds:
☐ Physical abuse
☐ Emotional or psychological abuse
☐ Failure to maintain spouse
☐ Abandonment
☐ Domestic violence
☐ Substance abuse
☐ Imprisonment
☐ Adultery
☐ Failure to fulfil marital obligations
☐ Other
Details:
9. Mahr (Dowry)
Was Mahr agreed upon at the time of marriage?
☐ Yes
☐ No
Amount of Mahr:
R ___________________
Was the Mahr fully paid?
☐ Yes
☐ No
☐ Partially
Outstanding amount (if any):
R ___________________
10. Children
Are there any children born of the marriage?
☐ Yes
☐ No
If yes:
| Child Name | Date of Birth | Gender |
|---|---|---|
With whom do the children currently reside?
Are there any disputes concerning:
☐ Care and Contact
☐ Guardianship
☐ Maintenance
☐ Education
☐ Religious Upbringing
11. Financial Matters
Do the parties own any immovable property together?
☐ Yes
☐ No
Is maintenance currently being paid?
☐ Yes
☐ No
Are there any financial disputes between the parties?
☐ Yes
☐ No
If yes, provide details:
12. Domestic Violence
Have there been any incidents of domestic violence?
☐ Yes
☐ No
Has a protection order been obtained?
☐ Yes
☐ No
If yes, provide details:
13. Supporting Documents
Please attach copies of the following where available:
☐ ID or Passport
☐ Nikah Certificate
☐ Civil Marriage Certificate
☐ Birth Certificates of Children
☐ Existing Court Orders
☐ Proof of Maintenance Payments
☐ Protection Orders
☐ Correspondence relating to Divorce
☐ Other Supporting Documents
14. Additional Information
Please provide any additional information relevant to your matter:
Declaration
I declare that the information provided in this questionnaire is true and correct to the best of my knowledge and believe it to be complete.
Client Name: ___________________________
Signature: ___________________________
Date: ___________________________
Disclaimer
The completion of this questionnaire does not create an attorney-client relationship and does not constitute legal advice. Information provided will be used for preliminary assessment purposes only. Legal advice can only be provided once a formal consultation has taken place and a mandate has been accepted. Islamic divorce requirements may vary according to the applicable school of Islamic jurisprudence and individual circumstances. Clients are encouraged to obtain independent religious guidance where necessary.