Imam & Muazzin Registration

Aafiyah Health Card registration, only for Imams and Muazzins.

* Fields marked * are required.

1. Applicant's Personal Information

Full Name*

Applicant's photo (Optional)

JPG or PNG. It will be resized automatically.

Designation*

Imam Muazzin

Aadhaar Card Number

Date of Birth*

Blood Group

Mobile Number*

Complete Residential Address*

City / Tahsil*

District

Akola

2. Mosque Information

Name of the Mosque*

Complete Address of the Mosque*

For how many years have you been serving as an Imam/Muazzin?*

years

Monthly Remuneration (Salary)

Letter from Masjid Administrator (Mutawalli)*

Photo of the signed letter or a PDF, up to 4 MB.

3. Other Income Details

Do you have any other source of income?

Yes No

4. Family Details

Only add details of family members who need Aafiyah health benefits.

Father

Full Name

Aadhaar Number

Mother

Full Name

Aadhaar Number

Wife

Full Name

Aadhaar Number

5. Children's Details

Only add children who need Aafiyah health benefits.

6. Declaration

I hereby declare that all the information provided in this form is true and correct to the best of my knowledge and belief. I authorize Roti Bank, Akola to verify and authenticate the information provided herein whenever required.

I agree to the declaration above.*

I consent to Flying Colours Education Foundation storing these details, including my family's and children's details, and using them for the Aafiyah Health Card Project.* Read our Privacy Policy

Imam & Muazzin Registration

Thank you! Your registration has been received.