On this Thursday, the ….th day of ….. corresponding to 19.. A.D., corresponding to .. …….th day of ……, 14……A.H at ……..p.m., at the Cairo Registry Office, before and through me ………….., Notary Public at said office, and in the presence of:
1- Name: ................. Residence: ................. I.D. :................ Nationality:................

2- Name: ................ Residence: ............... I.D. : .................. Nationality: ...............
Being witness of legal age and legally eligible in accordance with Article 8 of the Executive Regulations implementing the Registration Law,

Appeared
Name : .................. Date of Birth: ............... Place of Birth: ...............Nationality: ................. Religion: ................ Profession: ............... Residence:................. I.D:.............. ,
and said that he had married:
Name : .................. Date of Birth: ............... Place of Birth: ...............Nationality: ................. Religion: ................ Profession: ............... Residence:................. I.D:..............

By virtue of marriage contract registered with the Personal Status Office,No: ......... in ../../, and that he had lawfully lived with her as husband and wife and that now he wanted to divorce her revocably for the first time, and said: “My wife with whom I consummated marriage, Ms…………………….. is divorced from me a first revocable divorce.”

In witness whereof, this attestation has been made, that Mr. ………….. hereby divorces his wife Ms. ……………….. and after read out, attestation was signed by me and those present.

Divorcee: .................. First Witness:................... Second Witness: .................... Notary:..................... .