The deadline for applications is 5pm on Friday 24th May 2019. Before you apply please ensure you meet the criteria listed below.

• a) You must be a UK resident (we have already filled our quota for non UK residents for Hajj 2019).
• b) You must be eligible to receive Zakat.
• c) You must NOT have performed Hajj before in your life time.
• d) You should have no immediate family who have the financial means to pay for your Hajj.

Priority is given to the sick and elderly.

Name	:	*
City of Residence	:	*
Post Code (Full address is not needed. Part postcode is acceptable).	:	*
Mobile Phone Number	:	*
Landline Phone Number	:	*
Email Address	:	*
Age	:	*
Do you have children?	:	Yes No
What are the ages of your children and what do they do for a living? If not applicable please enter N/A	:
What is the maximum distance that you can walk unaided per day ? Eg. Only a few metres, approximately 1 mile, more than 1 mile etc.	:
Why should you be considered for our free Hajj programme? Please provide as much information as possible	:
Additional Information:
If you are completing this form on behalf of someone else then please add your contact details here and provide any other additional information that you feel that we need to know.	:
		(Last 3 digits on the back of your credit / debit card)
Captcha	: