Kebajikan .01.

A ( )

PHOTO
(Attached soft copy)

ZAKAT FUND REQUISITION FORM

A) PERSONAL
BUTIR PERIBADI
INFORMATION
PEMOHON

NAME

NRIC Place of Birth Race

No. ID No.Telefon No H/P

Permanent Address:

Current Address:

B) EDUCATION

Program Semester Year of Intake

Loan (Sponsorship) RM per Sem Duration

C) FAMILY INFORMATION
Father's Name

Occupation

Income

Employer's address

Mother's Name

Occupation

Income

Employer's address

Name of Dependant Age School/College/Univ

C) JUSTIFICATION

I require the financial assistance from Zakat Fund to:

If orphan, please state:

D) Did you ever received Zakat previously ? If Yes, please state :

E) DECLARATION

I hereby certify that all the above information given are true. If it is found to be false or inaccurate later, I understand that the
Management of Zakat Fund UniKL MIMET has the right to withdraw or blacklist me from receiving any benefits in the future.

Date : Signature :

F) Campus Lifestyle (CL) Recommendation:

G) COMMITTEE'S DECISION
After deliberately discussed your application, Committee has found out that you have met all the requirements for Zakat
and as such we have agreed to grant you Zakat amounting RM _____________ for this year.

Attention:

Please attach the following documents :-

1) Salinan
Student Kad
Identity
Pelajar
Card (IC)
2) Student ID Card
3) Salinan
Salary payslip
gaji terkini
( Parents
ibu/bapa/penjaga
/ both father ataupun
& motherpengesahan
) OR net income
pendapatan
statement
yangthat
disahkan
certifiedoleh
trueKetua
by Penghulu
kampung
or Ketua Kampung
4) Photocopy of convertion card to Islam ( Muallaf)
5) Attach other related documents if any

* Approval will be given based on Zakat Fund availability