Moya Membership Application - AYA Clients - 2024 (One Member Complete)

Applicant Information
Title
Full Legal Name (the “Applicant”)*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityProvince

Postal CodeCountry
Date of Birth*

MonthDayYear
MM/DD/YYYY Birth Date
SIN*
Social Insurance No
Email*
example@example.com
Employer Name*
Occupation (Role / Title)*
Doctor, Teacher, Manager, Etc
Employment Type*
Industry: Financial Services, Healthcare, Engineering, etc
Personal Phone*
Work Phone
Identification #1 (must be a photo ID)
Document Type
Reference Number
ID Reference #
Expiry Date

MonthDayYear
Date
Place and Country of Issue
Ie: Toronto, Canada
Identification #2
Document Type
Reference Number
ID Reference #
Expiry Date

MonthDayYear
Date
Place and Country of Issue
Ie: Toronto, Canada
Politically Exposed Person (PEP) Declaration

I declare that I am not a PEP.I declare that I am a PEP, as described on the Politically Exposed Person Statement, attached
Are you a Canadian Resident?

YesNo
Witness

Applicant Information 2
Title
Co-applicant Name

First NameLast Name
Co-applicant Address

Street Address

Street Address Line 2

CityProvince

Postal CodeCountry
Date of Birth (2)

MonthDayYear
Birth Date
SIN (2)
Social Insurance No
Co-applicant Email
example@example.com
Co-applicant Employer Name
Occupation (Role / Title)
Doctor, Teacher, Manager, Etc
Employment Type
Industry: Financial Services, Healthcare, Engineering, etc
Personal Phone
Work Phone
Document Type
Reference Number
ID Reference #
Expiry Date

MonthDayYear
Date
Place and Country of Issue
Ie: Toronto, Canada
Document Type
Reference Number
ID Reference #
Expiry Date

MonthDayYear
Date
Place and Country of Issue
Ie: Toronto, Canada
Politically Exposed Person (PEP) Declaration

I declare that I am not a PEP.I declare that I am a PEP, as described on the Politically Exposed Person Statement, attached
Are you a Canadian Resident?

YesNo

Sukuk - Savings Account / Term Deposit Confirmation
TERM DEPOSIT DETAILS – SHARIAH COMPLIANT
Amount (the “Principal”)*
Amount you will deposit into your halal bank account
Type of Deposit Product / Account

Halal Savings Bank Account (No Fee account)1 Year Redeemable - up to 72% returns1 Year Non-Redeemable - up to 80% returnOther - Call me to discuss options
Depositor's Signature- Applicant 1*

Clear
Depositor’s Signature- Applicant 2

Clear
Date*

MonthDayYear
Date of Acceptance ie. Today's Date
DISCLAIMER AND TERMS & CONDITIONS
- A Representative will be in contact with you to confirm the details of your submission with respective terms prior to any initialization of the deposit.
- Do not worry, we will not initiate the transfer till one of our representatives are in touch with you.
- Thank you for your submission and we will be in touch.
Initials for Term Deposit Type
Your initials, ie. For Mustafa Khan type MK

Personal (Member) Application