Our Services Zakat Application NBIC Zakat Application 2 Please fill out the following form to completion. New Brunswick Islamic Center 1330 Livingston Avenue, North Brunswick, Unit #4, NJ 08902 Phone: (732) 807-NBIC E-mail: zakat@nbic.org Web: http://www.nbic.org Fill in every part below. For sections that you cannot answer, put “Not Applicable (N/A)” or “0”. The contents of this form will remain confidential. Distribution of Zakat is reviewed by committee and distribution is based upon need and ability. Name * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### Home Number * Email * Marital Status * Married Single Social Security Number * Number of Dependents * Driver License Number * Do you own a car? * Yes No Do you rent or own your home? * Rent Own How many people live with you? * Assets Cash on hand? * $ Cash in Checking/Savings/Money Mkt. etc.? * $ Real Property * Additional Assets * Debts/Expenses: Please state the amount Total Debt: * $ Car * $ Credit Cards * $ Student Loans * $ Other Loans * $ Bank Line of Credit * Insurance * $ Personal Loans * $ Rent / Mortgage * $ Utilities * $ Medical * $ Monthly Expenses/Debt Car Payment * $ Student Loan * $ Utilities * $ Credit Card * $ Rent/Mortgage * $ Insurance * Others (Please Explain) * Current Employment Name of Company * Part or Full Time: * If part time, how many hours a week do you work? Salary in $ per hour or yearly: * $ Other Income: * Explain what specific assistance you need? * Have you applied anywhere else for assistance? Have you applied anywhere else for assistance? * If yes, where else have you applied? * E-Signature * Please type your name below to certify that all the information given in this application is correct and that I am eligible to receive Zakat funds from NBIC. Date * MM DD YYYY Thank you for your submission! We will be in touch soon, insha’Allah. The contents of this form will remain confidential. Distribution of Zakat is reviewed by committee and distribution is based upon need and ability.Jazakum Allahu Kheirun
