Service Request

Request a service from the BASIQAT Charitable Association

Your full name

National number (ID number)

Nationality

Your E-mail

Mobile number

gender
manwoman

City

the address

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Type of Request
Medical (treatment or medication)HelpEducational
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A photo of the national ID

The attached file

Please attach the supporting files to accept your application, whether a copy of electricity, a certificate, etc

Other information (optional)