Anjuman-e-Shujaee Qardan Hasanah Houston, Texas

Qardan Hasanah Application Requirements

Requirements • Application form duly completed and signed • Written consent of at least two Mumineen to be Guarantors • In case of Business need, provide (i)business details and plan, (ii) last two years financial statements and (iii) last two years returns of existing business. • Collateral in the form of gold/jewelry Guidelines • The Qardan Hasanah Committee may call upon Applicant and Guarantor(s) • Each Application will be considered on its own merit and no explanation will be given for its decision • The Applicant may be required to provide written evidence as part of the application • Incomplete application will be returned Please note that if your application is approved, it will be subject to at least the following conditions: • The applicant providing post-dated checks for all the installment payments covering the entire Qardan Hasanah • Each guarantor providing post dated checks for the amount of Qardan Hasanah guaranteed

For Office Use Only

Applicant's Name

Date Application ID

Check No. Check Date Check Amt.

Aamil Saheb Signature and Remarks:

Bank Name & Address:

B. Occupational/Financial

Employer Address:

Employer Name:

Years of Service:

Net monthly income of all earning family members

Name Occupation Income

Monthly Savings

Bank Accounts Type and No. of Accts.

Gold JewelryOwn Home

Own Business Other

Net Equity

Net Equity

Value

Value

Bank Name & Address:

Personal Assests

A. Personal

Name:

Address:

Age:H Phone: C Phone: MarriedSingle

Email:

Hadiyat Mufsuhiyat

Dawat Titles and Honors

Date:

Educational Qualifications & Completion Date

Wajebaat offered last Shehrullah Mubarak Status in the community

Title(s) / Date(s)

Degree(s) / Certificate(s) with dates

Responsibilities held with dates

Date:

C. Qarzan Hasanah RequirementAmount of Qarzan Hasanah required

1. Property Purchase

Category Requirement

2. Business Purchase 3. Ziyarat 4. Payment of interest bearing loans 5. Others

Have you applied elsewhere for this loan? If yes, from whom?

Do you owe Qarzan Hasanah to other sources? If yes, from whom?

No Yes $Do you owe any Qarzan Hasanah loans to Dawat-e-Hadiyah?

Yes $No

ValueAddress

1. Property Purchase

Total cost of transaction Remaining cost of transaction to be obtained from

Date when contracts are to be exchanged Proof(s) enclosed (give details)

Total CostAddress

Date purchased/purchase to be finalizedType of Business

2. Business Purchase

3. Ziyarat

Date of travel Total Cost

How is ziyarat to be financed

Date obtainedOriginal amount of loan

4. Payment of interest bearing loan

Amount Outstanding

Purpose of loan

Where obtained

Proof(s) enclosed (give details)

If Qarzan Hasanah covers part of the above loan, state how the rest is to be obtained

Date required Total Cost

Purpose of Qarzan Hasanah

5. Other

Financial details

How many number of monthsMonthly installments of

Source of funds for repayment (if not adequately explained above)

D. Repayment

Name:

Address:

Phone:

Position in community (with dates)

Honors/Titles

SignatureSignature

Name:

Address:

Phone:

Position in community (with dates)

Honors/Titles

The above information is to the best of my knowledge true and correct. I agree to abide by the rules and regulations of the scheme. Moved by the irshadaat of Al-Dai-Al-Fatemi, His Holiness Dr. Syedna Mohammed Burhanuddin Saheb (TUS) regarding the important principle of Islam, viz: the total refraining from ALL DEALING in interest, whether it be its taking, or its giving or even it's witnessing. I resolve that I shall never under any circumstances enter into this sinful practice. UI confirm that besides that listed in this application, I do not have any further dealings in interest.

No. of unexpired years if mortgagedProperty Deeds

Description should be provided in 3 copies. Where the value is in excess of ,000.00 valuation certificates must be provided.

Value $Gold Jewelry

E. Securities Offered

Abde Syedna (TUS),

Guarantors

Note: If business is already purchased, complete both sections 2 & 4. If you own your own business(es), give details

We the undersigned having read this application form, support the application of Qarzan Hasanah by the applicant. We understand that we are co-debtors and agree to repay this loan if the principle debtors fails to do so himself.

This agreement is executed between herein after referred to as

"Borrower" and 1. and 2.

herein after referred to as "Guarantors" and Mr.

representing Anjuman-e-Shujaee Qarzan Hasanah Committee herin after referred to as "Lender".

Whereas it is agreed between the "Borrower", the "Guarantors" and the "Lender" as Under:

1. The Lender agrees to lend the Borrower a sum of $ as Qarzan Hasanah loan.

2. The Borrower agrees to repay the exact amount of Qarzan Hasanah to the Lender in (20) monthly installments of $

each beginning from .

3. The Borrower will deposit gold/jewelry and/or title deeds to property or automobiles etc. owned by the Borrower with the Lender in a

Safe Deposit Box in the name of the Lender as a Collateral Security for the loan and will also provide the Lender with (2) Guarantors

acceptable to the Lender for the period of the loan.

4. The Guarantors agree that if due to any reason the Borrower fails to pay any installment or installments or if the Borrower's check for the

repayment is dishonored by the bank, the Guarantors will immediately upon receiving notice from the Lender, which may be either verbal

or in writing at the option of the Lender, pay to the Lender the due installment/installments within two business days of receipt of such

notice. Such payment when received will be credited to the Qarzan Hasanah Loan Account of the Borrower.

in witness whereof the undersigned have executed this Agreement on this day of 2010.

Agreement

2. Guarantor

1. GuarantorBorrower

I, the undersigned declare that I have deposited the Gold/Jewelry as per the following details with

on this day of 20 .

1.

ValueDescriptionNo.

2.

3.

4.

5.

7.

6.

Received for Anjuman-e-Shujaee Qarzan Hasanah Committee by:

Received in original condition (After Loan Repayment)

Secretary Treasurer

1. Witness 2. Witness

Borrower Name Borrower Signature Date

Borrower Signature Date

Anjuman-e-Shujaee Qardan Hasanah Houston, Texas

Receipt of securities offered

Application ID