Canada Zakat accepts applications from those deserving of Food Services

Our Food Distribution Committee rigorously examines the Food Services applications using criteria and procedures reviewed and approved by local Islamic scholars. You can fill the online application below

WAIVERS:

1. I understand that the personal information collected through this application will be used only for the purposes of assessing my current financial position as described by me herein. The collection of this information is authorized under Section 33(c) of the Freedom of Information and Protection of Privacy Act and the privacy protection provisions of that Act will protect it.
Agree Disagree 

2. I give Canada Zakat, a project of DawaNet, permission to verify and substantiate my financial status using the references provided by me in this application.
Agree Disagree 

SECTION 1: PERSONAL INFORMATION


Applicant’s Full Name:*
Spouse’s Full Name (if applicable):
SIN (Social Insurance #) Applicant: SIN Spouse:
Address:*
City: Postal Code: Prov.
Email:* Date of Birth (DD/MM/YY)
Primary Phone #:* Spouse’s Telephone:
Occupation (current or last) Spouse’s occupation:
Applicant Employer’s Name (current or last): Telephone:
Spouse’s Employer’s Name (current or last): Telephone:


# Name of child Age Gender
1
2
3
4
5
6
7
8

SECTION 2: Food CATEGORY & ESTIMATE OF NEED

Please check off (all if they apply) which category of Food Services you are applying for: Note, Quarterly option will be reviewed once a month*

 Disabled Elderly (over 65) Elderly (over 65) and Disable Other

SECTION 3: Food Pick Up Delivery & Duration

Please check off (all if they apply) which category of Food Services you are applying for: Note, Quarterly option will be reviewed once a month*

 Pick up Delivery (mobility constraints) One Time One Month One Quarter (3 months)

SECTION 4: FINANCIAL INFORMATION

A: Have you previously applied to a Food Bank within Peel before?

If Yes, provide name here: Date last received:

B: Please detail your combined sources of MONTLY income below (including all members of
family). Please provide proof in all cases (e.g.: Employer cheque stub, Ontario Works
payment, etc.).

#
Source of Income Monthly Amount (most recent)
1
Employment Income
2
Child Tax Credits
3
Government Assistance Program (Government sponsored refugees only)
4
Federal and Provincial Social Assistance
5
Disability Benefits
6
Child and/or Spousal Support
7
Zakat Income from other mosques
8
Travelling Income (if Traveler)
9
Other:
Total

B: Please detail your MONTHLY expenses and debt obligations below:

#
Expense Monthly Amount (most recent)
1
Rent
2
Utilities
3
Food
4
Personal Bills (e.g.: Cell phone, etc.,)
5
Non-Riba Debt (credit card/mortgage debt does not apply).
6
Travelling expenses (if Traveler)
7
Other:
Total

C: Please list and detail the value of assets you fully own:

#
Assets Value
1
House
2
Car(s), boat(s)
3
Jewelry
4
Other:
Total

D: Financial Position Total Monthly Difference (Total A – Total B) =

Total Asset Value (Total C) =

Please explain in detail why you need the Zakat assistance:*

SECTION 4: REFERENCES

Please provide names and contacts of 2 individuals in the community, not your family members, who can verify your personal and financial situation.

#
Name Phone Address
1
2

'Please provide a copy of your ID and proof of all your monthly income in all cases (e.g.: Employer cheque stub, Government Assistance Program, etc. disability)'

Note: You application will rejected if you do not provide these documents. If you don't have any source of income, please note that in the detailed response section. Thanks'




***************** Thank-you for completing this application ***********************