Membership Form | Sakan-e-Sheza

Before you begin: This application is for disabled and specially-abled women seeking shelter and care at Sakan-e-Sheza, Karachi. All information is kept strictly confidential. Applications are reviewed within 5–7 working days. For help call +92 324 2754300.

Personal
Info

Family &
Health

Guardian
Info

Documents
& Submit

Personal Information

Fill in your details exactly as they appear on your CNIC.

First Name *

Last Name *

Date of Birth *

Gender *

I confirm I am female (only females are eligible)

CNIC Number *

Profession (if any)

Current Address *

Contact Number *

Secondary Contact (optional)

Email Address (optional)

Family & Health Information

Provide your family background and health details. Please be as descriptive as possible.

Family Information

Father's Name *

Spouse Name (if applicable)

Number of Children *

Highest Education *

Health Information

Type of Disability *

Please describe your disability in detail — type, severity, and how it affects your daily life.

Daily Activities Assistance (optional)

Do you require help with daily activities such as bathing, dressing, eating, or mobility? If yes, describe.

Medical Conditions & Current Medications (optional)

Describe any ongoing diseases or medical conditions and list current medications if any.

Guardian Information

Provide details of your guardian or next of kin for emergency contact and legal purposes.

Guardian Name (if applicable)

Relationship with Applicant *

Guardian CNIC *

Guardian Contact Number *

Note: If you do not have a guardian, please write "None" in the Guardian Name field and provide details of a trusted contact person in the remaining fields.