Zakat Ul Maal Application Form

A. Personal Information

Note: Answer all questions. Do not leave anything blank. If not applicable, write N/A. Incomplete applications will not be considered.

First Name:*

Middle Name

Last Name:*

Applicant's Date of Birth*

Applicant's Legal Status in Canada*

Spouse's Information (if you don't have it type N/A)

First Name:

Middle Name:

Last Name:

Spouse's Date of Birth

Spouse's Legal Status in Canada

Address:*

City:*

Postal Code:*

Telephone: (Home)

Work:

Cell Phone:*

Spouse's Telephone:

Applicant's Employer (Current or Last)

Please enter your current or last employer information if you have been working. Otherwise type "Unemployed" if you are not working.

Applicant Occupation:*

Employer Name:

Address:

Phone

Spouse's Occupation:*

Employer Name:

Address:

Phone

Number of Applicant’s Dependants (Children)

No.

Name:

Sex:

Age:

GR:

School:

B. Income ($/month)

Your income:*

Spouse’s income:*

C. Value of Assets ($)

Home(s):*

Car(s): *

Other asset(s): *

Expenditures ($/month)

Accommodation:*

Food & Clothing: *

Others expenses: *

Assistance from Zakat/Sadaqah (if funds available, and approved by the committee) How much are you requesting;

I authorize the Hamilton Downtown Mosque and its Affiliate bodies or its designated committee to obtain such factual & investigative information as permitted by the law to verify information in this application

Applicant's Signature (Your name)*

Date

Spouse's Signature (Spouse Name)*

Date

Upload*

NOTE: Please attach the following documents: 1) Prove of Income 2) Two Month Bank Statement 3) Utilities bills 4) Rent 5) Notice of Assessment ALLOWED FILE EXTENSIONS: jpg, jpeg, png, gif, pdf

This field should be left blank