Registration Form for Qurbani Mecca - Aqiqah Centre

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Registration Form for Qurbani Mecca

Participant’s Details
"So pray to your Lord and sacrifice [to Him alone]"
Registerer’s Name*
Full name
Contact Number*
Email*
Receiving Address for Participation Certificate (Home/Office/PO Box)*
Address City State Poscode Country
Participant’s Details

Qurban Participant’s Name*

Participant’s Name	Number of Goat

(If you would like to register more than 1 participant, please click at the (+) button to add. Kindly note the number of goats for each participant)

Total of Goats*
Lafaz Niat & Akad Qurbani
“I/We hereby give Aqiqahcentre.com under the management of AC AGROTECH SDN BHD (1366280-T) and/or their representative the authority on performing Qurban on our behalf for the name above mentioned on the year 1444 Hijrah / 2023 Masehi LILLAHI TAALA”
Total
RM 0.00
Credit Card*
Card Details
Cardholder Name

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