Hajj 2021/1442AH Form

Please fill the form below and proceed to make your payment online via the page that loads after form submission or use the account details provided for your transaction.

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?

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 2020?

Yes No

Did you make any payment for Hajj 2020?

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

Hajj 2021/1442AH Form

Please fill the form below and proceed to make your payment online via the page that loads after form submission or use the account details provided for your transaction.

Fill the form below to put us on the wheel.

SECTION 1.1 - ALL ABOUT YOU

SECTION 1.2 - YOUR CONTACT ADDRESS

SECTION 2 - YOUR PASSPORT DETAILS

IF YOU HAVE ANSWERED 'NO' TO THE QUESTION ABOVE, PLEASE ANSWER THE FOLLOWING

SECTION 3.0 - YOUR FAMILY

3.1 - About Your Spouse

3.2 - About Your Children

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

SECTION 5.1 -MEDICAL HISTORY

Do you suffer any of the following illness(ess)?

Section 5.2: If you have answered yes to any of the Medical History questions, please answer the questions in this section

Please note: a medical report will be required to certify that you are fit to travel.

SECTION 6 - FINANCES AND EMPLOYMENT DETAILS

SECTION 7 -RETURNING CUSTOMER

REQUEST FOR ADDITIONAL SERVICES/INFORMATION

NEXT OF KIN

DECLARATION

Hi!