Zakah Application Form

Zakah Application Form

Fill out the form carefully to be eligible to receive zakah.
I First Name* Last Name* confirm that my total assets (excluding personal assets which have been used in the past year) after deducting my outstanding debts do not exceed Type a label* (the value of 87.47 grams of scrap gold) on this date Date*
Birth Date*

MonthDayYear
Gender*
If under the age of 15, I confirm that I have reached puberty. If over 15, please skip.*

YesNoSkip
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*

Recipient Student Information

Please fill in student information. Please note, all data collected from this form will remain anonymous.
Student Age*
Islamic Studies Subject/Program:*

AlimHifzOther
Alim Course Progress*
Hifz Program Progress*
Tell us your story. Please provide 3-5 sentences. Explain how a scholarship will help you continue your studies, OR has helped you so far in your studies. Please include some additional details about yourself (student) such as your hobbies away from school, and your future goals as a student. *
Please provide as much details as you can.

Fixed Property (a)

Other Fixed Property (b)

Movable Assets (c)

Current Assets (d)

	Value ($)
Gold,Silver(According to Value)
Cash on Hand
Deposits in Bank
Money Deposited elsewhere
Stocks and Shares
Debtors
Other Assets
TOTAL (d)

Home Finance (a)

Vehicle Finance (b)

Other Liabilities (c)

I, First Name Last Name appoint the zakah administrators of Najam Institute to use the zakah funds I am eligible for and pay blank dollars to Type a label on my behalf.
Signature

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Recipient Student Information