Declaration of Revocable Divorce

​In the name of God, the compassionate, the merciful
 
The Hashemite Kingdom of Jordan
Supreme Judge Dept
 
Shariah Court in: [Location]
Ref. No.: [Number]
Date: [Date AH]
Corresponding to: [Date AD]
 
Declaration of Revocable Divorce
 
In the legal council convened by me, [Name], Islamic judge of Amman, [Region], I received the legally capable [Name] of Amman. He was identified by the legally capable persons [Name] and [Name], of Amman. The aforementioned [Name] declared, “On August 5, 1985, I divorced my wife, with whom I had legally consummated my marriage, [Name], by telling her ‘You are divorced.’ I was conscious of what I said and intended to divorce her in a legally sound condition. I obtained an Islamic religious ruling as such from the Islamic Religious Ruling Department in Amman under No. [Number] on [Date]. I request registration of my declaration and for her to be duly notified thereof.” As this declaration and issuance has been made by the aforementioned [Name], and it has been verified to us that they were previously married and consummated such marriage by his own declaration and the testimony of the aforementioned identifying persons, I have informed him that he has divorced his aforementioned wife, [Name]. The divorce is revocable as long as it was not preceded by two divorces, and she is entitled to the legal waiting period from the aforementioned date of divorce. Registration of this divorce has been declared and she has been duly informed, issued on [Date AH] corresponding to [Date AD].
 
Clerk
//signed//
 
Shariah Judge of Amman, [Region]
//signed and stamped//
-           Certified and attested by the Shariah Court in Amman, [Region], Jordan
 
//six other illegible signatures//