POI Registration Form

Information for the referring doctor / person :
1. Please fill in the name of the child, contact information andChecklist signature of a parent/legal guardian. 2. WhatsApp a clear picture of the form and the latest prescription to 03086770106. Save the hard copy. Certificate 3. Please lodge a complaint by calling at 051-8313214 in case you do not receive an acknowlegement within 05 working days. copy of Child 4. Please inform the parent / legal guardian to expect Meethi Zindagi's representative to contact them for further Mother documentation. 5. Once the documentation process is completed, the child will be supported until they reach the adult age of 18 years, or in case of Child college/university education, the age of 21 years.
1) Registration Form 2) School Admission Form/Result
3) Birth Certificate /CNIC Card
5) Hospital Prescription Copy 6) 2x Passport Size Picture of
Personal Information:
7) Electric and Gas Bill Copies 8) Nisab Calculation Form
Name of the child
Gender
Eligibility:
Zakat/Donation
Religion / Ethnicity
Class
City
School Name and Address
Date of birth
MonthDayYear
Date
Date of birth
MonthDayYear
Date
Year
Residential Address
Postal Address (if different from residential address)
Parent's Informatio
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Father's Name
Father's Occupation
Father's Contact
Father's CNIC Number
Mother's Name
Mother's CNIC Number
Mother's Occupation
Mother's Contact
Medical Information
Referred by (Dr. & Hospital name)
Glucometer Owned
YesNo
Diagnosed on
Diagnosed on
Family history of Diabetes (Type)
Year
HbA1c (At the time of registration)
Other medical info (if any)
Complications / conditions at time of registration
EyeFootKidneysCardiovascularOther
Consent by Parent / Legal Guardian on behalf of the child:
I wish to register my child for support from Meethi Zindagi. I give
my consent to Meethi Zindagi, its affiliates and agents, to use my
Latest prescriptionSchool registrationCNIC of father and / or motherNisab calculation
image and details, in accordance with its data privacy policy. This
consent includes, but not limited to (tick all that apply):
authorities only
This consent is given for use on public media.This consent is given for restricted sharing with sponsors
Registere
Date
MonthDayYear
Date
MonthDay
Year
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Should be Empty:

Personal Information:

Eligibility:

Zakat/Donation

Parent's Informatio

Medical Information

Registere