Application

Empowerment Fund

Please fill out the form carefully to apply for empowerment and business assistance.

Applicant Information

First Name *

Middle Name

Last Name *

Passport Photo *

Max: 2MB (JPG, PNG)

Phone Number *

ID Number *

ID Copy *

Marital Status *

County *

Address *

Financial Information

Income Source *

Monthly Income (KES) *

Receiving Support from Other Organizations? *

Organization Name

Support Amount (KES)

Monthly Expenses (KES)

Rent *

Gas *

Water *

Electricity *

Food *

Medical *

Education *

Loan Repayment *

Other Expenses

Debt Information (Optional)

Debtor Name

Debtor Phone

Amount Owed (KES)

Empowerment Fund

Applicant Information

Family & Spouse Information

Financial Information

Monthly Expenses (KES)

Debt Information (Optional)

Your Situation & Referee

Referee & Documents

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Address

Empowerment Fund

Applicant Information

Family & Spouse Information

Financial Information

Monthly Expenses (KES)

Debt Information (Optional)

Your Situation & Referee

Referee & Documents

Stay Updated with everything Zakat!

Stay Updated with
everything Zakat!