FORM 'A

FORM 'A
The Honorary Secretary

Khoja (Pirhai) Shia Isna Asheri Jamaat

Karachi.

I, the undersigned am Khoja by birth and follow Shia Isna Asheri faith and desire to be enrolled as an ORDINARY / LIFE / PATRON member of Jamaat.

I agree and accept to abide by the Constitution and Bye Laws of KPSIAJ and any subsequent amendments which shall come into force from time to time.

I opt to be:
- ORDINARY Member by paying life time subscription of Rs. 250
- LIFE Member by paying life time subscription of Rs. 5,000
- PATRON Member by paying life time subscription of Rs. 25,000
My particulars and details of my family members are given hereunder:
Name*
Father / Husband Name*
Grand Father /Husband’s Father’s Name*
Surname*
Date of Birth*

DayMonthYear
Date
Place of Birth*
Age
Present Resident City*
Marital Status*
Occupation*
CNIC
Citizenship No
In case of Foreign National
Passport No
In case of Foreign National
Address Line 1*
Address Line 2
Cell No*
Tel Res
Tel Office
Email
example@example.com
Add Family Details

YesNo

Family Members

Please enter details of your family members
Family Member 1 Name
Family Member 1 Relation
Family Member 1 Date of Birth

DayMonthYear
Date
Family Member 1 Age
Family Member 2 Name
Family Member 2 Relation
Family Member 2 Date of Birth

DayMonthYear
Date
Family Member 2 Age
Family Member 3 Name
Family Member 3 Relation
Family Member 3 Date of Birth

DayMonthYear
Date
Family Member 3 Age
Family Member 4 Name
Family Member 4 Relation
Family Member 4 Date of Birth

DayMonthYear
Date
Family Member 4 Age
Family Member 5 Name
Family Member 5 Relation
Family Member 5 Date of Birth

DayMonthYear
Date
Family Member 5 Age
Family Member 6 Name
Family Member 6 Relation
Family Member 6 Date of Birth

DayMonthYear
Date
Family Member 6 Age
CurrentDate

DayMonthYear
Date

Signature of Applicant

Clear
Date

DayMonthYear
Date
We know the above applicant and the above information is correct to the best of our knowledge. We recommend enrolling him as a member of the Jamaat
Recommender 1 Name
Recommender 1 Father Name
Recommender 1 Surname
Recommender 1 JCIC
Recommender 2 Name
Recommender 2 Father Name
Recommender 2 Surname
Recommender 2 JCIC

Membership Type
I opt to be:

ORDINARY Member by paying life time subscription of Rs. 250LIFE Member by paying life time subscription of Rs. 5,000PATRON Member by paying life time subscription of Rs. 25,000
Please transfer {iOpt} to the following account and either paste text from the transaction email or upload the account transfer confirmation image (along with the transaction reference number)

Bank: Habib Metropolitan Bank Limited, IBB - Soldier Bazar Branch, Karachi.

Title of Account: KHOJA (PIRHAI) SHIA ISNA ASHERI JAMAAT

Account No: 6-99-98-29319-714-100261

IBAN: PK85 MPBL 9998 7371 4010 0261
Are you transferring online?*

YesNo
Online transfer confirmation

TextScreenshot
Amount transfer confirmation text
Copy complete text along with reference number from your confirmation email.
Amount transfer confirmation image

Cancelof
Please verify that you are human*
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