Islamic Will Application Form

Your Details

Full Name*

First Last

Address*

Street Address Address Line 2 Suburb State Postcode Country

Email*

Daytime Phone No*

Mobile Phone No

Date of Birth

Gender*

Male

Female

Occupation*

How well do you read English?

Spouse's Full Name (if married)

First Last

Children / Dependants

Click the + icon to add more children/ dependants

Name

Date of Birth

Three Elected Executors

It is your appointed executor who will carry out the terms of your will. Please list your chosen executors in preference order:

Executor 1: Full Name*

First Last

Executor 1: Address*

Street Address Address Line 2 Suburb State Postcode Country

Executor 1: Gender*

Male

Female

Executor 1: Relationship*

Executor 2: Full Name

First Last

Executor 2: Address

Street Address Address Line 2 Suburb State Postcode Country

Executor 2: Gender

Male

Female

Executor 2: Relationship

Executor 3: Full Name

First Last

Executor 3: Address

Street Address Address Line 2 Suburb State Postcode Country

Executor 3: Gender

Male

Female

Executor 3: Relationship

Bequest

In accordance with the Islamic Shariah principles you are able to allocate 1/3 of your assets by way of bequest (not compulsory). These assets can be distributed to person(s)/or organisation(s). Note: percentages are to be out of 100% where 100% represents the full 1/3 portion to be distributed. If you wish to distribute less than the full 1/3 then please provide the relevant percentage e.g. 50% would mean you are allocating half of the 1/3. If you acknowledge your right to bequest up to one third of your estate at your discretion, however you choose not to do so (in which case the 1/3 will be distributed in accordance with the remaining 2/3 under the Mawarith Schedule division), please leave this page blank and the percentage will remain at 0%. If you would like to obtain further information about the 1/3 bequest prior to completing this form, please contact our office.

Bequest 1: Full Name

First Last

Percentage

%

Address

Street Address Address Line 2 Suburb State Postcode Country

Bequest 2: Full Name

First Last

Percentage

%

Address

Street Address Address Line 2 Suburb State Postcode Country

Bequest 3: Full Name

First Last

Percentage

%

Address

Street Address Address Line 2 Suburb State Postcode Country

Total*

%

Total is over 100% please correct

Total must be 100% please correct

Zakat

If you have unpaid zakat payable as an Islamic debt at the time of your death, this payment may be paid out of your estate. Accordingly, please provide the full legal name of your preferred charity and their address.

Full Legal Name of Charity Organisation

Address of Charity Organisation

Street Address Address Line 2 Suburb State Postcode Country

Guardian (Optional)

You may include in your Will your selection as to who you wish to be appointed guardian of your children under 18 if your spouse does not survive you:

Would you like to add a guardian?*

Yes

No

Guardian 1: Full Name*

First Last

Guardian 1: Address*

Street Address Address Line 2 Suburb State Postcode Country

Guardian 1: Relationship*

Would you like to add another guardian?*

Yes

No

Guardian 2: Full Name*

First Last

Guardian 2: Address*

Street Address Address Line 2 Suburb State Postcode Country

Guardian 2: Relationship*

Would you like information about a Shari’ah Compliant Enduring Guardian?*

Yes

No

Would you like information about a Shari’ah Modified Power of Attorney?*

Yes

No

I acknowledge that I have read this document and I confirm that I have requested an Islamic Will notwithstanding being told by Kelloway Law and Mediation that they have not provided any legal advice to me regarding the appropriateness of the Islamic Will in my circumstances. I acknowledge by submitting this Application form, that I have engaged Kelloway Law and Mediation to draft my Islamic Will. I acknowledge that I will be billed for all work done on my behalf. I acknowledge that the cost of obtaining an Islamic Will is $550 (incl GST) for an individual and/or $880 (incl GST) for a couple.