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Apply for Elderly Muslim Fund Zakat Foundation™
الله هو الله وحده I testify “La ilaha illa Allah, Muhammad rasoolu Allah.”
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I testify in front of Allah that All application information provided on this form is true and accurate to the best of my knowledge and I give consent to background checks regards medical/confidential information to be released to Zakat Foundation
I am a Muslim & I believe there is no God but Allah and Muhammad is His messenger
Required
Section 1: 𝐀𝐩𝐩𝐥𝐢𝐜𝐚𝐧𝐭'𝐬 𝐃𝐞𝐦𝐨𝐠𝐫𝐚𝐩𝐡𝐢𝐜 𝐃𝐚𝐭𝐚
All Data should be verified by zakat foundation™ .YOU MUST HAVE YOUR OWN MOBILE NUMBER AND EMAIL ID .
Gender
*
Transgender
👳♂️Male
🧕Female
Full Name
*
Your answer
🏛️ Number given by Government / government id card number
*
Your answer
(Driver's License/ID Number) YOU HAVE TO UPLOAD THIS ID AFTER SUBMISSION OF THIS FORM
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Your answer
Detail Address 🏚️ ( we send volunteer from your country to check and hand over zakat📦after verification )
*
Your answer
City
*
Your answer
State
*
Your answer
Pin Code/Zip
*
Your answer
Country
*
Your answer
Primary Mobile Phone Number
*
Your answer
Secondary Phone Or Mobile Number
Your answer
E-mail
*
Your answer
Age: as on government document
*
Your answer
Section 2: Applicant's Circumstances Number of Dependents
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Column 1
1 Dependents 🧕👳♂️
2 Dependents 🧕👳♂️
3 Dependents 👳♀️🧕👳♂️
4 Dependents 👳♀️🧕👳♂️🧕
5 Dependents 🧕🧕🧕👳♀️👳♂️
6 Dependents 🧕🧕👳♀️👳♂️🧕🧕
7 Dependents 🧕🧕👳♀️👳♂️🧕🧕👳♂️
8 Dependents 🧕🧕👳♀️👳♂️👳♂️🧕🧕👳♂️
Column 1
1 Dependents 🧕👳♂️
2 Dependents 🧕👳♂️
3 Dependents 👳♀️🧕👳♂️
4 Dependents 👳♀️🧕👳♂️🧕
5 Dependents 🧕🧕🧕👳♀️👳♂️
6 Dependents 🧕🧕👳♀️👳♂️🧕🧕
7 Dependents 🧕🧕👳♀️👳♂️🧕🧕👳♂️
8 Dependents 🧕🧕👳♀️👳♂️👳♂️🧕🧕👳♂️
Place of Residence
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Rental Apartment
Own Home
Shelter
Subsidized Housing
Government Shelter
Other:
Employment Status
*
Unemployed
Self-Employed
Part-Time
Full-Time
Small Business
If employed, where
Your answer
Job Title
Your answer
Job Contact Number
Your answer
Marital Status
*
Single
Married
Widowed
Divorced
Separated
If married, name of spouse
Your answer
Is your spouse currently employed?
YES
NO
Clear selection
If yes, where
Your answer
Education
*
College Grad or More
Some College
High School Grad
Some High School
No High School
Unknown
Health Insurance
Insured
Uninsured
Clear selection
Describe reason for which You apply for Zakat State the reason you are in need, how much you need and how assistance for all or part of total from Zakat fund will meet your need
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Your answer
Total household monthly income
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Your answer
What is your living status?
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I live by myself
I live with my spouse (husband or wife)
I live with my children
I live with my spouse and children
Total household monthly expenditure:
*
Your answer
Loans/debt you owe:
*
Your answer
List the names and phone numbers of anyone with whom you are familiar with, and can substantiate the information you provided above.
*
Your answer
Name of local Masjid or Muslim community Center:
*
Your answer
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