CDMFAS Form

CAPITAL DISTRICT MUSLIM FUNERAL AID SOCIETY (CDMFAS)

(NON-PROFIT CHARITABLE ORGANIZATION) Mailing address: 24 Semons Avenue Latham NY 12110 Tel: 518-288-6914 · http://www.muslimfuneralaid.com · cdmfas@gmail.com
Principal Applicant
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Contact Number

Area CodePhone Number
Email Address*
Phone Number:*
Other Members of the Household
Terms and Conditions
- Note: In case of CDMFAS member’s death, CDMFAS will pay all funeral expenses, and later this cost will be equally divided to all the principal applicants only and their share will be withdrawn from their account after 72 hours of Salatul Janazah. This will be the last time their account is used.
- All the members will be informed by email before the withdrawal of the monetary amount.
- CDMFAS will deduct the share amount from the associated bank account automatically in case a death in the community.

Fee*

Service FeeDeducted first time to enroll the account for automatic deduction

$5.00

Total

$0.00

Principal Applicant