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In the name of Allah, the Gracious, the Merciful.
Majlis Ansarullah Canada
Nasir Name
Member Code
Majlis Name
Email
Which prayers are offered in congregation normally (select as applicable)
 Fajr
 Zuhr
 Asr
 Maghrib
 Ishaa
No. of prayers offered on average in a day last month (out of 5)
No. of Friday prayers offered in Mosque/Namaz Centre in last month
No. of Friday Sermons of Huzur(aa) listened to in last month
No. of days recited Holy Qur`an with translation in last month
 Less than 5 days a month (0 - 5)
 Between 6 and 18 days a month (6-18)
 More than 18 days a month (>18)
Did you write letter to Huzur(aa) last month
Are you willing to offer yourself for Waqf e Arzi?
If yes, When?
If yes, Where?
Do you exercise / play sports regularly?
Can you provide help in finding job?
If you can help in job, what is your field?
Do you own a bicycle?
Have you visited elderly and sick
 No
 Once a week
 Once a month
 Once a quarter
Can you donate blood and organs (select as applicable)
 Blood
 Organs
Has your physical checkup done during last six months?
Please select any of the below skills that you have: (May check more than one)
Urdu or English Composing
Social Media (Twitter etc.)
Graphic designing or website development
Writing skills
Number of Tabligh contacts
CommunityNo of Tabligh contacts
Muslim
Christian
Jew
Sikh
Hindu
Other
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