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Block 12, Suites 13-15, Odua Intl Model Plaza, Ojota, Lagos.
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Hajj 2022/1443AH Form
Please fill the form below
Contact Us
Fill the form below to put us on the wheel.
PACKAGE
Basic
Standard
Standard Plus
Executive
ARE YOU A NEW CUSTOMER?
Yes
No
HOW LONG HAVE YOU KNOWN US?
HOW DID YOU HEAR ABOUT US?
Radio Advert
TV Advert
Billboard
Social Media
SMS
WhatsApp
Newsletter
Referral
Others
SECTION 1.1 - ALL ABOUT YOU
FULL NAME
SEX
Male
Female
DATE OF BIRTH
PLACE OF BIRTH
NATIONALITY
MARITAL STATUS
FATHER'S FULL NAME
MOTHER'S FULL NAME
WHAT IS YOUR RELIGION?
WHAT SECT OF YOUR RELIGION DO YOU BELONG?
WHAT LANGUAGE(S) DO YOU SPEAK FLUENTLY?
WHAT IS YOUR QUALIFICATION?
WHAT IS YOUR PROFESSION?
IF YOU ARE SELF EMPLOYED, PLEASE STATE CLEARLY WHAT YOU DO
SECTION 1.2 - YOUR CONTACT ADDRESS
HOME ADDRESS
BUSINESS ADDRESS
MOBILE NUMBER
EMAIL ADDRESS
SECTION 2 - YOUR PASSPORT DETAILS
DO YOU POSSESS A VALID INTERNATIONAL PASSPORT?
Yes
No
UPLOAD CLEAR DATA PAGE OF PASSPORT
UPLOAD CLEAR PASSPORT PHOTOGRAPH WITH WHITE BACKGROUND
PASSPORT NUMBER
ISSUE DATE
EXPIRY DATE
PLACE OF ISSUE
IS THIS YOUR FIRST INTERNATIONAL PASSPORT?
Yes
No
IF YOU HAVE ANSWERED 'NO' TO THE QUESTION ABOVE, PLEASE ANSWER THE FOLLOWING
PREVIOUS INT'L PASSPORT NUMBER
PREVIOUS INT'L PASSPORT ISSUE DATE
PREVIOUS INT'L PASSPORT EXPIRY DATE
PREVIOUS INT'L PASSPORT PLACE OF ISSUE
SECTION 3.0 - YOUR FAMILY
3.1 - About Your Spouse
IF YOU ARE MARRIED, WHAT IS YOUR SPOUSE' NAME?
SPOUSE' DATE OF BIRTH
SPOUSE' NATIONALITY
STATE OF ORIGIN
PROFESSION
QUALIFICATION
SPOUSE' PRESENT JOB
SPOUSE' PHONE NUMBER
IS YOUR SPOUSE TRAVELLING WITH YOU?
Yes
No
3.2 - About Your Children
DO YOU HAVE CHILDREN?
Yes
No
If you have answered yes to this question, kindly note that further details will be required to be sent to us.
SECTION 4 - PREVIOUS APPLICATION
HAVE YOU PERFORMED UMRAH BEFORE?
Yes
No
HAVE YOU PERFORMED HAJJ BEFORE?
Yes
No
HAVE YOU EVER HAD CAUSE TO STAY IN SAUDI KINGDOM FOR UMRAH PERIOD TO HAJJ PERIOD?
Yes
No
HAVE YOU APPLIED FOR A SAUDI VISA BEFORE?
Yes
No
HAVE YOU EVER BEEN REFUSED A VISA FOR SAUDI?
Yes
No
HAVE YOU EVER BEEN REFUSED ENTRY TO SAUDI OR HAD TO LEAVE TO ENTER OR REMAIN CANCELLED?
Yes
No
HAVE YOU EVER BEEN REFUSED A VISA FOR ANOTHER COUNTRY?
Yes
No
SECTION 5.1 -MEDICAL HISTORY
Do you suffer any of the following illness(ess)?
Tuberculosis
Yes
No
Migraine/Headache
Yes
No
Diabetes
Yes
No
High/Low Blood Pressure
Yes
No
Whooping Cough
Yes
No
Asthma
Yes
No
Hemorrhoid/Pile
Yes
No
General body ache after little stress
Yes
No
Rheumatism
Yes
No
Section 5.2: If you have answered yes to any of the Medical History questions, please answer the questions in this section
How often do you have this illness?
When was your last treatment?
Is your illness hereditary?
Yes
No
Have you had any serious illness or disease in the past that have been cured?
Yes
No
What was the nature of the illness?
How long did you suffer from the illness?
What was the medication/drug administered on you?
Do you require any special attention or assistance during your stay in Saudi Arabia due to old age?
Yes
No
Do you require a wheel chair or stretcher in performing your rites?
Yes
No
Do you have any form of deformation?
Yes
No
If Yes, please state your deformation
Please note: a medical report will be required to certify that you are fit to travel.
SECTION 6 - FINANCES AND EMPLOYMENT DETAILS
What is your present job?
When did you start the job?
Work address
Telephone Number
Email Address
How much money is available to you for your stay in Saudi Arabia?
Who is paying for your pilgrimage?
Sponsor's Contact Address
Sponsor's Telephone Number
SECTION 7 -RETURNING CUSTOMER
Did you register for Hajj 2021?
Yes
No
Did you make any payment for Hajj 2021?
Yes
No
Form of payment
Amount Paid
Date of payment
Receipt Number
REQUEST FOR ADDITIONAL SERVICES/INFORMATION
NEXT OF KIN
Full Name
Occupation
Telephone Number
Email Address
Address
DECLARATION
I hereby certify that the above statements are true to the best of my stay in Saudi Arabia. I shall abide by all the laws and regulations of the Kingdom, I am aware that alcohol, drugs, narcotics and indecent publications violating public morality and all types of religious or political pamphlets are prohibited from entering the kingdom of Saudi Arabia. Whether for personal use or otherwise, I accept that if I violate the laws and regulations of the kingdom of Saudi Arabia; I shall be subjected to a penalty. I am aware that Airline ticket, once issued before notification of cancellation cannot be refunded.
Full Name
On this date
Submit
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