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- Who referred you to this form?
- Who is filing this application?*
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- Is the applicant's current residence owned or rented?*
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- Select the choices that are applicable to your immediate and extended family members:*
- Does the applicant qualify for any of these categories? If yes, please select:*
- Is the applicant Non-Muslim? (Solely asked for the purposes of determining Zakat-eligiblity).*
- Is the applicant Syed/ Shia? (Solely asked for the purposes of determining Zakat-eligiblity).*
- Does the applicant own property or possessions that make a total of Rs. 52,000 or more?*
- Do you consider yourself as Zakat eligible?*
- Do you consider yourself as Khums eligible?*
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- We can only send the funds directly to the institution where you need to pay your bills (school, hospital, etc). Please confirm with the institution, how do they accept payment?
- Have you requested funds from friends and family members first?*
- Have you approached other organizations or funding groups to help with this case?*
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- Should be Empty: