Empowerment Fund Application

Applicant Information

First Name *

Middle Name

Last Name *

Passport Photo *

Phone Number *

ID Number *

ID Copy *

Marital Status *

County *

Address *

Spouse Information

First Name

Middle Name

Last Name

Phone Number

ID Number

Family Information

Number of Children *

Total Family Members *

Disabled? *

Children Details (Names & Ages) *

Family Members Details *

Disability Type

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)

Your Situation

What Are You In Need Of? *

Explain How We Can Help *

Amount Requested (KES) *

How Did You Hear About Us? *

Previous Applications (If any)

Referee Information

First Name *

Middle Name

Last Name *

Phone Number *

Relationship to Applicant *

Referee Document (Letter from Imam or Darul Kheir Area Representative.) *

Supporting Documents

Upload Supporting Documents *

You can upload multiple files as a ZIP archive.

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Empowerment Fund Application

Applicant Information

Spouse Information

Family Information

Financial Information

Monthly Expenses (KES)

Debt Information (Optional)

Your Situation

Referee Information

Supporting Documents

Our Pillars

Contact Us

+254 727 634 212

info@darulkheir.org

Empowerment Fund Application

Applicant Information

Spouse Information

Family Information

Financial Information

Monthly Expenses (KES)

Debt Information (Optional)

Your Situation

Referee Information

Supporting Documents

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Our Pillars

Contact Us

+254 727 634 212

info@darulkheir.org