CONFIDENTIAL
SYARIAH COURT
Registration Form
IMPORTANT NOTICE
Please complete and submit this form with photocopies of the following documents:
a.
b.
c.
d.
Marriage Certificate / Revocation Certificate;
Identity Card (front and back) OR Passport
Children’s Birth Certificates; and
Protection Order / Maintenance Order / Conversion Letter (to Islam) if any
Incomplete forms and/or insufficient documents attached WILL NOT BE
ACCEPTED for registration. We seek your co-operation in this matter. Please note
that rejected forms will be returned to your address.
The completed form and documents may be:
A) submitted personally for registration at
Syariah Court,
Family Link @ Lengkok Bahru
8 Lengkok Bahru #03-01
Singapore 159052
Tel:
6354 8371
Working Hours Monday to Friday, 8.30 am to 5:00 pm
OR
B)
mailed to:
Manager
Syariah Court,
Family Link @ Lengkok Bahru
8 Lengkok Bahru #03-01
Singapore 159052
Please post ONLY PHOTOCOPIES of official certificates and documents.
Please note that your application will be processed within 4 – 6 weeks.
For more information, please refer to our website: www.syariahcourt.gov.sg
COPYRIGHT NOTICE
All rights reserved. No part of this form may be reproduced, stored in any
retrieval system, or transmitted in any form or by any means, whether
electronic or mechanical, including photocopying and recording, without the
permission of the Syariah Court. Information contained in this form is strictly
confidential and shall not be used in any court proceedings.

Page 1 of 20
CONFIDENTIAL
FOR OFFICIAL USE ONLY
Remarks
Case Number
Complainant
1
Husband
2
Wife
Resolution
1
2
3
4
Revocation/Remarriage
Nullity
Marriage Counseling
Divorce
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CONFIDENTIAL
Please answer by filling in the blanks, encircling the number(s) or letter(s) where appropriate. Sections marked
with * are MANDATORY fields.
Part 1: Personal Particulars
Section A: Personal Particulars
1.
Name *
2.
Alias as in NRIC, if any *
3.
NRIC/ID No *
4.
ID type *
1
Singapore Pink IC
2
Singapore Blue IC
3
Foreigner ID Number
5.
Date of birth *
6.
Sex *
1
7.
Male
2
Female
Age *
1
Below 21 years old
7
45 to 49 years old
2
21 to 24 years old
8
50 to 54 years old
3
25 to 29 years old
9
55 to 59 years old
4
30 to 34 years old
10
60 to 64 years old
5
35 to 39 years old
11
65 to 69 years old
6
40 to 44 years old
12
70 years old and above
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CONFIDENTIAL
8.
9.
10.
11.
12.
Ethnic group *
1
Malay
2
Chinese
3
Indian
4
Arab
5
Others, please specify:
Educational level *
1
No formal education
5
University Degree and Above
2
Primary or lower (includes PSLE)
6
VITB/ITE
3
Secondary (includes N and O levels)
4
Post secondary (A level, Diploma)
7
Religious Education
Gardener or fishermen
Occupation *
1
Professional
6
2
Legislators, Senior Officials and Managers
7
Production craftsmen and related workers
8
Drivers, machine operators, labourers and
related workers
9
Unemployed [GO TO Q12]
3
Associate professional and technicians
4
Clerical workers
5
Sales and Services workers
Net monthly salary *
1
Below $1,000
4
$4,000 to $5,999
2
$1,000 to $1,999
5
$6,000 to $7,999
3
$2,000 to $3,999
6
$8,000 or more
2
Permanent Resident (PR)
Citizenship *
Foreign citizen , please specify:
1
13.
Singapore citizen
3
Nationality *
Section B: Particulars of Spouse
14.
Name *
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Page 4 of 20
CONFIDENTIAL
15.
Alias as in NRIC, if any *
16.
NRIC/ID Number *
17.
ID type *
1
Singapore Pink IC
2
Singapore Blue IC
3
Foreigner ID Number
18.
Date of birth *
19.
Sex *
1
20.
21.
22.
Male
2
Female
Age *
1
Below 21 years old
7
45 to 49 years old
2
21 to 24 years old
8
50 to 54 years old
3
25 to 29 years old
9
55 to 59 years old
4
30 to 34 years old
10
60 to 64 years old
5
35 to 39 years old
11
65 to 69 years old
6
40 to 44 years old
12
70 years old and above
Ethnic group *
1
Malay
4
2
Chinese
5
3
Indian
Arab
Others, please specify:
Educational level *
1
No formal education
5
University Degree and Above
2
Primary or lower (includes PSLE)
6
VITB/ITE
3
Secondary (includes N and O levels)
7
Religious Education
4
Post secondary (A level, Diploma)
8
Unreported
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CONFIDENTIAL
23.
24.
25.
Occupation *
1
Professional
6
Gardener or fishermen
2
Legislators, Senior Officials and Managers
7
Production craftsmen and related workers
3
Associate professional and technicians
8
Drivers, machine operators, labourers and
related workers
4
Clerical workers
9
Unemployed [GO TO Q25]
5
Sales and Services workers
10
Unreported [GO TO Q25]
Net monthly salary *
1
Below $1,000
4
$4,000 to $5,999
2
$1,000 to $1,999
5
$6,000 to $7,999
3
$2,000 to $3,999
6
$8,000 or more
2
Permanent Resident (PR)
7
Unreported
Citizenship *
Foreign citizen, please specify:
1
26.
Singapore citizen
3
Nationality *
Section C: Marriage Details
27. Reason for filing application with Syariah Court *
28.
29.
1
Marriage Counseling
3
Revocation/Remarriage
2
Divorce
4
Nullity
Number of occasions you have filed application with Syariah Court about your current marriage *
1
Never
3
2 times
5
4 times
2
1 time
4
3 times
6
5 times or more
Whether divorce has been pronounced by husband *
1
30.
Yes
2
No [GO TO Q33]
Date/dates on which divorce was pronounced *
1
D
D
M
M
Y
Y
Y
Y
3
D
D
M
M
Y
Y
Y
Y
2
D
D
M
M
Y
Y
Y
Y
4
D
D
M
M
Y
Y
Y
Y
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CONFIDENTIAL
31.
Words uttered when divorce was pronounced *
32.
Number of divorce pronouncements made to date by husband throughout the current marriage *
33.
1
1
3
3
5
5
2
2
4
4
6
6 or more
2
No
Whether this is your first marriage *
1
34.
Number of occasions you have been married *
1
35.
Once
2
Twice
3
3 times or more
Date of solemnization of current marriage *
D
36.
Yes [GO TO Q35]
D
M
M
Y
Y
Y
Y
Your age when you first married *
1
Below 21 years old
7
45 to 49 years old
2
21 to 24 years old
8
50 to 54 years old
3
25 to 29 years old
9
55 to 59 years old
4
30 to 34 years old
10
60 to 64 years old
5
35 to 39 years old
11
65 to 69 years old
6
40 to 44 years old
12
70 years old and above
37.
Marriage certificate number *
38.
Place where marriage was registered *
1
Registry of Muslim Marriages, Singapore
(ROMM)
2
Registry of Marriages, Singapore (ROM)
3
Overseas, please specify:
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CONFIDENTIAL
Section D: Children’s details
39. Children from current or previous marriage
1
40.
Yes
2
No [GO TO Q43]
Number of children
A
From current marriage
B
From previous marriage/relationship
C
Adopted children
D
Total number of children (A + B + C)
41. Particulars of children from current marriage *
Name
Birth certificate number
Sex
Date of Birth
Status ( Schooling/
working/ unemployed)
B1)
C1)
D1)
E1)
B2)
C2)
D2)
E2)
B3)
C3)
D3)
E3)
B4)
C4)
D4)
E4)
B5)
C5)
D5)
E5)
B6)
C6)
D6)
E6)
A1)
A2)
A3)
A4)
A5)
A6)
42.
Number of children living in your household
A
Section E: Family Structure
43.
Housing *
1
Living in rented house/flat
2
Living in own house/flat
3
Living with parents/family/friends
4
Staying in a sheltered home/institutions
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CONFIDENTIAL
44.
Type of housing *
1
HDB 1 – 3 rooms
3
HDB 5 rooms/Executive
Apartment/Massionette/
Executive Condominium
5
Landed Property
2
HDB 4 rooms
4
Private Apartments
6
Sheltered home/institutions
45. Number of people in your household including yourself
A
46. Head of household
1
Self
3
2
Spouse
4
Husband and wife, jointly
Others, please specify:
47. Provider in household
1
Self alone
3
2
Spouse alone
4
Spouse and self
Others, please specify:
48. Care of family members
Family members
A
Young Children
[< 12 yrs old]
B
Family Members
with Special
Needs
C
Aged
[> 65 yrs old]
1
Care required
(Indicate
Yes/No)
2
Number of family
members who
require care
3
Relationship to
Respondent
49. Are you the primary care giver?
1
Yes [GO TO Q51]
2
No
50. Primary care giver
1
Spouse
4
Other Relatives
2
Children
5
Others, please specify:
3
Parents or Parents-in-law
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CONFIDENTIAL
Part 2: Marital Issues and Social Network Questions
Section F: Reasons for coming to Syariah Court
Section F1: Desertion
51. Has your spouse deserted you/Have you deserted your spouse? *
1
Yes
2
No [GO TO Q55]
52. Who is the deserter?
1
Spouse
2
Self
3
Both spouse and self
53. Length of desertion
A
Spouse
B
Self
54. Do you know the current whereabouts of your spouse?
1
Yes
2
No
Section F2: Parents/Parents-in-Law
55. Do you quarrel with your spouse because of your parents/parents-in-law? *
1
Yes
2
No [GO TO Q58]
56. Are your parents/parents-in-law living with you?
1
Yes
2
No
57. Describe the circumstances that lead to quarrels because of parents/parents-in-law.
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CONFIDENTIAL
Section F3: Incarceration/Imprisonment
58.
Is incarceration/imprisonment the cause of your quarrel with your spouse? *
1
Yes
2
No [GO TO Q66]
59. Who was incarcerated / imprisoned?
60.
61.
62.
1
Spouse
2
Self
3
Both spouse and self
Date of incarceration.
Spouse
D
D
M
M
Y
Y
Y
Y
Self
D
D
M
M
Y
Y
Y
Y
Spouse
D
D
M
M
Y
Y
Y
Y
Self
D
D
M
M
Y
Y
Y
Y
Date of release.
Number of occasions incarcerated
Spouse
Self
63.
Offences committed that lead to incarceration. You may provide multiple responses. [MA]
1
Drugs
1
Robbery
1
White collar crimes (i.e. fraud)
1
Outrage of modesty
1
Illegal assembly
1
Others, please specify:
64.
Circumstances that led to spouse’s/your incarceration.
65.
Prison/Drug Rehabilitation Centre where your spouse/you are/were being held *
Spouse
Self
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CONFIDENTIAL
Section F4: Children
66. Do you quarrel with your spouse because of the children? *
1
Yes
2
No [GO TO Q69]
67. Whether any of the following reasons leads to quarrels. You may provide multiple responses. [MA]
1
Different ways of disciplining the child/children
1
2
Self / spouse not involved in children’s education
1
3
Self / spouse providing insufficient money for children’s
maintenance
1
4
Others, please specify:
1
68. Details of quarrels with children being the primary cause.
Section F5: Addiction (Substance)
69. Do you quarrel with your spouse because of addiction problems? *
1
Yes
2
No [GO TO Q72]
70. Who is having addiction problems?
71.
1
Spouse
2
Self
3
Both spouse and self
Details of addiction problem.
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CONFIDENTIAL
Section F6: Renunciation of Islam
72. Is your spouse/Are you renouncing Islam? *
1
Yes
2
No [GO TO Q75]
73. Who is renouncing Islam?
1
Spouse
2
Self
3
Both spouse and self
74. Spouse’s/your reasons for renouncing Islam.
Section F7: Sex
75. Do you have any sexual problems with your spouse? *
1
Yes
2
No [GO TO Q77]
76. Details of the sexual problems that you have
Section F8: Financial Problems
77. Are there any financial problems in your marriage? *
1
Yes
2
No [GO TO Q81]
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CONFIDENTIAL
78. Who is causing / contributing to the financial problems?
1
Spouse
2
Self
3
Both spouse and self
79. Enumerate (as many as necessary) the financial problems that you are facing in your marriage. You may
provide multiple responses. [MA]
1
Unemployment
1
Inability to service car loan
1
Unwillingness to work
1
Inability to service Hire Purchase payment
1
Inability to work
1
Indebtedness to relatives/friends/family
1
Gambling
1
Failure to provide regular allowance/maintenance
1
Inability to control spending /buying habits
1
Indebtedness to loan sharks
1
Constant demand for money
1
Problem in settling medical expenses
1
Inability to service credit card debt
1
Problem in settling children’s expenses
1
Inability to service housing mortgage
1
Others, please specify:
80. Details of the financial problems that you encounter in your marriage.
Section F9: Domestic Violence
81. Has your spouse been abusing you/Have you been abusing your spouse? (Physically, verbally,
psychologically and emotionally)? *
1
Yes
2
No [GO TO Q85]
82. Who is the abuser?
1
Spouse
2
Self
3
Both spouse and self
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CONFIDENTIAL
83. Nature of abuse/abuses your spouse/you have suffered. You may provide multiple responses. [MA]
1
Physical
1
Isolation (controlling behavior – disallowing you
from going out or visiting own family or friends.
1
Verbal
1
Others, please specify:
1
Psychological
1
Emotional
84. Details of the nature of abuse you/your spouse have suffered.
Section F10: Infidelity/Extra-Marital Affair
85. Are there infidelity/extra-marital affair problems in your marriage? *
1
Yes
2
No [GO TO Q89]
86. Who is unfaithful / having extra-marital affairs?
1
Spouse
2
Self
3
Both spouse and self
87. Details of the infidelity/extra-marital affairs.
88. As of today, have the infidelity/extra-marital affairs ended?
1
Yes
2
No
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CONFIDENTIAL
Section F11: Other Factors Affecting Marriage
89. Are there any other factors affecting your marriage? *
1
Yes
2
No [GO TO Q91]
90. Other factors affecting marriage.
Section F12: Most Important PROBLEM Affecting Marriage
91. Choose only ONE of the factors listed below that is instrumental in your decision to come to Syariah
Court. *
1
Desertion
2
Parents/ Parents-in-Law
3
Incarceration/Imprisonment
4
Children
5
Addiction (Substance)
6
Renunciation of Islam
7
Sex
8
Financial Problems
9
Domestic Violence
10
Infidelity/Extra-Marital Affairs
11
Other Factors Affecting Marriage
Section G: Support Network
92. Other than your spouse, are there other people in your family whom you can turn to for help? *
1
Yes
2
No [GO TO Q96]
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CONFIDENTIAL
93. Who in your family has the most influence over you about your marriage?
1
Father
5
Brother
9
Father-in-law/Mother-in-law
2
Mother
6
Sister
10
Brother-law/Sister-in-law
3
Grandfather
7
Uncle/Aunt
Others, please specify:
11
4
Grandmother
8
Cousin
94. Have you told your [INSERT Q93 ANSWER] about your marriage problems? *
1
Yes
2
No [GO TO Q96]
95. What advice did your [INSERT Q93 ANSWER] give you about your marriage problems? *
1
Proceed with the divorce
3
Give the marriage another try
Others, please specify:
2
Attend the Marriage Counseling Program
4
95A. If Q95 = 1, please share with us the reason for your [INSERT Q93 ANSWER] advising you to proceed with
the divorce.
96. Do you have a close friend you can turn to for help? *
1
Yes
2
No [GO TO Q99]
97. Have you confided in your close friend about your marriage problems? *
1
Yes
2
No [GO TO Q99]
98. What advice did your close friend give you about your marriage problems? *
1
Proceed with the divorce
3
Give the marriage another try
Others, please specify:
2
Attend the Marriage Counseling Programme
4
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CONFIDENTIAL
98A. If Q98 = 1, please share with us the reason for your close friend advising you to proceed with the divorce.
Section H: Marriage Counseling
99. On a scale of 10 to 1, with 10 being the highest and 1 the lowest, rate your interest in going for
marriage counselling to resolve your marital problems and reconcile with your spouse. *
Very Interested
10
Less interested
9
8
7
6
5
4
3
2
1
99A. If Q99 = 1 to 5, please share with us the reason for your disinterest in marriage counseling.
100. Would you like your spouse to attend the marriage counseling session with you? *
1
Yes
2
No
3
Not Sure
101. On a scale of 10 to 1, with 10 being the highest and 1 the lowest, rate the likelihood of your spouse
agreeing to attend marriage counselling session with you. *
Very likely
10
Most unlikely
9
8
7
6
5
4
3
2
102. Are you agreeable to having a family member with the most influence in your marriage involved in
your marriage counseling? *
1
Yes
2
No
103. Are you agreeable to involving a close friend in your marriage counseling? *
1
Yes
2
No
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1
CONFIDENTIAL
104. How many marriage counseling sessions would you like to attend? *
1
1 session
3
3 sessions
2
2 sessions
4
4 sessions
5
5 sessions or more
105. On a scale of 10 to 1, rate your chances of proceeding with divorce after attending marriage
counselling, with 10 being the Highest and 1 the Lowest. *
Very likely
10
Most unlikely
9
8
7
6
5
4
3
2
105A. If Q105 = 8 to 10, please share with us your reason for feeling that marriage counseling will not help you
reconcile with your spouse.
Section I: Resource Person (Asatizah)
106. Would you like an Ustaz/Ustazah to be involved in your marriage counselling?
1
Yes
2
No
Section J: Additional Remarks
107. Any additional information which you feel is relevant.
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1
CONFIDENTIAL
Contact Information
Please provide the following contact information
Yourself
Name
Telephone No.
(Mobile)
(Home)
(Office)
(Mobile)
(Home)
(Office)
Address
Your Spouse
Name
Telephone No.
Address
DECLARATION
I hereby declare that the information I have provided is true to the best of my knowledge. I understand and accept
the requirements stipulated in this form.
____________________________
Signature
Name: ________________________________
____________________
Date
NRIC Number: ________________
COPYRIGHT NOTICE
All rights reserved. No part of this form may be reproduced, stored in any
retrieval system, or transmitted in any form or by any means, whether
electronic or mechanical, including photocopying and recording, without the
permission of the Syariah Court. Information contained in this form is strictly
confidential and shall not be used in any court proceedings.

Page 20 of 20