Hajj / Umrah Application





Untitled Document

HAJJ – Tick required box and include costs
6 Weeks

5 Weeks

4 Weeks

Package Option:

Flight
R

Package:


Extended Stay: Yes
No


 
Optional
Azizia Couple/Family Room
R

Aqsa:


Additional Night Med / Aqsa:


   
 
TOTAL COST:


 
 
UMRAH – Tick required box and include costs
Package Type (group booking):


Tailor Made:


Flight

Other

TOTAL COST:


 
Mahrams Personal Details
Name:
Surname:
Passport Number:
ID Number:
Sahuc Pin Number:
Nationality:
Physical Address:
Cell No:
Work No:
Home No:
Email:
Previous Hajj: Yes

No:

Which year:
 
 
Names of Persons Travelling in Group
Person 1
Name:
Surname:
Passport No:
ID No:
Relation:
Previous Hajj: Yes

No:

Which year:
 
Person 2
Name:
Surname:
Passport No:
ID No:
Relation:
Previous Hajj: Yes

No:

Which year:
 
Person 3
Name:
Surname:
Passport No:
ID No:
Relation:
Previous Hajj: Yes

No:

Which year:
 
Person 4
Name:
Surname:
Passport No:
ID No:
Relation:
Previous Hajj: Yes

No:

Which year:
 
Next of Kin:
Name:
Relation:
Contact No:
 
Mazhab
Shafi
Hanafi
Maliki
Hanbali
Other
 
Do you make use of a wheel chair ?
Name of caregiver:
Airport Only
Land Only
Airport & Land
Please state reason:
*Please note that Khidmatul Awaam / Sahuc does not provide wheelchairs
 
Do you or any person travelling with you, have a medical condition ? Yes
No
Name of Person:
Asthma
High BP
Cancer
Epilepsy
Diabetes
Cardiac(Heart)
Dialysis

How Often:
Pregnant:
Do you have a clear bill of health to travel ? Yes or No
Do you require a paraplegic room ?

Other:

** Advise Pax on SAPS Clearance. KAPS WILL NOT BE HELD RESPONSIBLE FOR ANY DELAY OR DEPORT OF TRAVELLER BY PASSPORT IMMIGRATION. TRAVELLER MUST ENSURE THEY ARE CLEAR OF ANY CRIMINAL OFFENCE

 
Please state any important information that requires our attention (disability – reading/writing/deaf etc):
I confirm that the above info is correct and accurate:
Date: