In the name of Allah, the Most Gracious, the Most Merciful Muslim Ummah of North America (MUNA) 1033 Glenmore Ave. Brooklyn, NY 11208 | Tel: 718-277-7900 | Fax: 718-277-7901 | www.MuslimUmmah.org

Matrimonial Registration Request Form MUNA Social Services and Family Development Department

CANDIDATE INFORMATION

Full Name Nickname(s) Male Female

Address

City State ZIP Code

Cell Phone Work Phone Home Phone

Email Personal website

Age Date of Birth Height Weight

Place of Birth (State, Province, District, Country)

Please disclose any health conditions, allergies, or disabilities, if any:

Current Marital Status Single Divorced Widowed Do you have children? No Yes How many? What are their ages?

Academic background High School

Bachelors Masters in

Doctorate in Other degree(s) Professional background Are you currently employed? Yes No

If yes, where do you work? Position Income

Immigration status Permanent Resident US Citizen Other (please specify)

PARENT/GUARDIAN’S INFORMATION

Names and relationships

Address City State

Country Phone Email

Profession

Please enter any additional information about your family that you would like to share:

PERSONAL INFORMATION

Personal religious practice Hanafi Shafiee Maliki Hanbali Ahle Hadith Sunni Shi’ite Other (please specify)

Please write about your religious practices, in brief (ex: daily prayers, fasting, attending halaqas, visiting the masjid, etc.)

If you are a revert, please tell us, when did you accept Islam?

This question is only for Brothers I have a beard I don’t have a beard

This question is only for Sisters—I wear a: Headscarf Jelbab/Abaya Niqab None

Are you a smoker? I smoke I do not smoke

Official use only Registration #: Received date:

Year

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MUNA Matrimonial Registration Request Form Page 2 of 2

SPOUSAL PREFERENCES

Religious practices Sunni Shi’ite Other (please specify)Please write any religious practice preferences, in brief

This question is only for Brothers—preferences for a wife Headscarf Jelbab/Abaya Niqab No preference

This question is only for Sisters—preferences for a husband Beard No beard No preference

Are you fine with smoking? Yes No No preference

Ethnic background

I prefer my future spouse from my own ethnic background or country of origin (specify)

I have no preference

Immigration Status— I would prefer my future spouse is a US Citizen Permanent Resident Other

Marital Status— I prefer a spouse who’s Single Divorced Widowed

Children— I am willing to consider a spouse with existing children Yes No

ADDITIONAL INFORMATION

Please submit at least 3 personal and/or professional references

Name Relationship Phone

Name Relationship Phone

Name Relationship Phone

Please submit (non-returnable)

AGREEMENT

• I, hereby certify that the information given in this form is true, correct, and complete in all respects. If there is any incorrect information in this form, I may be removed from the process.

• I will promptly inform MUNA Matrimonial Team of any changes in the information provided above.• I authorize MUNA Matrimonial Team to utilize the information provided by me according to the needs of the service.• I pledge to keep all the information provided by the MUNA Matrimonial Team confidential.• If I get married at any time, I will inform the MUNA Matrimonial Team.• As the MUNA Matrimonial Team is only introducing 2 parties to each other, in the event of a failure to arrange a

marriage, I shall not hold MUNA Matrimonial Team or MUNA responsible. I agree to abide by decisions and rulingsgiven by MUNA National President or his designated representatives in matters of disputes and will abide by decisionsof MUNA, its National President, and/or their representatives.

Full Name

Signature

Date

One copy of a portrait, color photograph of you taken in the last three months A copy of your current, government-issued ID Your current professional or academic resume/CV (if applicable)

By submitting this form, I agree to a complete and thorough criminal and background check by MUNA Matrimonial Team. By signing this contract, I approve to a background check.

I am seeking my future spouse to be from a specific ethnicity or country (specify)

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In the name of Allah, the Most Gracious, the Most MercifulMuslim Ummah of North America (MUNA)1033 Glenmore Ave. Brooklyn, NY 11208 | Tel: 718-277-7900 | Fax: 718-277-7901 | www.MuslimUmmah.orgMUNA Social Services and Family Development Department

Gender: OffZIP Code: Are you currently employed: OffHeadscarf: OffJelbabAbaya: OffNiqab: OffNone: OffSunni_2: OffShiite_2: OffOther please specify_3: OffHeadscarf_2: OffJelbabAbaya_2: OffNiqab_2: OffNo preference: OffBeard: OffNo beard: OffNo preference_2: OffAre you fine with smoking: OffChildrenI am willing to consider a spouse with existing children: Off2 copies of a portrait color photograph of you taken in the last three months: OffA copy of your current governmentissued ID: OffYour current professional or academic resumeCV if applicable: OffFull Name: Cell Phone: Work Phone: Home Phone: Personal website: Date of Birth: Age: Height: Weight: Place of Birth: Health Disclosures: How many children?: What are their ages?: High School: Names and relationships: Address: Please enter any additional information about your family that you would like to share: Date of Conversion to Islam: Phone: Date: Marital Status: OffChildren?: OffBachelors in: Doctorate in: Other Degree(s): Income: Position: State: City: Country: Email: Profession: Personal religious practice: OffI have a beard: OffI smoke: OffReligious practices description: Religious practice preferences: Other personal religious practice: My own ethnic background: Name 1: Name 2: Name 3: Phone 1: Relationship 1: Relationship 2: Relationship 3: Phone 2: Phone 3: Other religious practices: Print Form: Different ethnic background: Specify immigration: Clear Form: Received date: Nickname(s): Registration #: Other Immigration Status: Immigration?: OffName: Name Certify: Masters in: H Year: O Year: M Year: B Year: D Year: Immigration 2: OffEthnicity Selection: OffMarital Status Pref: Off