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 ------------ Type of Request Medical (treatment or medication)HelpEducational ------------ [group medical873] Purchasing medicineTreatment in a hospital [/group] [group help] House repairFoodPaying the electricity billMarriageOthers [/group] [group edu] Cost of studying at universityCost of schoolKindergarten costsTraining courseOther [/group] 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)