General Funding The Funding ProcessCollect DocumentationSubmit Application General Funding Application 1Terms & Documents2Income & The Wife3The Husband & Marriage4Fertility Treatment & History5Children & Declarations InstagramThis field is for validation purposes and should be left unchanged.Terms & Required DocumentsTerms & Conditions(Required) I have read and accept the Terms & Conditions and have prepared the required documents listed below. Rabbi's Consent Form(Required)Accepted file types: pdf, jpg, jpeg, png, Max. file size: 10 MB. 3 Months' Bank Statements(Required) Drop files here or Select files Accepted file types: pdf, jpg, jpeg, png, Max. file size: 10 MB, Max. files: 6. 3 Months' Credit Card Statements Drop files here or Select files Accepted file types: pdf, jpg, jpeg, png, Max. file size: 10 MB, Max. files: 6. 3 Months' Salary Slips Drop files here or Select files Accepted file types: pdf, jpg, jpeg, png, Max. file size: 10 MB, Max. files: 6. 3 Months' Bond / Rent Statement Drop files here or Select files Accepted file types: pdf, jpg, jpeg, png, Max. file size: 10 MB, Max. files: 6. Ketubah & Civil Marriage Certificate(Required) Drop files here or Select files Accepted file types: pdf, jpg, jpeg, png, Max. file size: 10 MB, Max. files: 2. Financial Details Spreadsheet(Required)Accepted file types: pdf, xls, xlsx, Max. file size: 10 MB. IncomeIncome Status(Required) Both spouses earn an income One spouse earns an income Neither spouse earns an income The Wife's DetailsWife's Name(Required)Wife's Hebrew Name(Required)Wife's Mother's Hebrew Name(Required)Wife's Father's Hebrew Name(Required)Wife's Date of Birth(Required) DD slash MM slash YYYY Wife's Cell Phone(Required)Wife's Email(Required) Was the Wife born Jewish?(Required) Yes No Wife — Where were you converted? (Rabbinical court)(Required)Wife — Conversion date(Required) DD slash MM slash YYYY Does the Wife attend Mikveh?(Required) Yes No The Husband's DetailsHusband's Name(Required)Husband's Hebrew Name(Required)Husband's Mother's Hebrew Name(Required)Husband's Father's Hebrew Name(Required)Husband's Date of Birth(Required) DD slash MM slash YYYY Husband's Cell Phone(Required)Husband's Email(Required) Was the Husband born Jewish?(Required) Yes No Husband — Where were you converted? (Rabbinical court)(Required)Husband — Conversion date(Required) DD slash MM slash YYYY Marriage & Religious ObservanceDate of Marriage(Required) DD slash MM slash YYYY Do you observe Shabbos and Kashrut?(Required) Yes No Which Shul do you attend?Rabbi's Name(Required)Is your Rabbi aware of your fertility treatment?(Required) Yes No Current Fertility TreatmentFertility Doctor's Name(Required)Fertility Clinic(Required)Doctor's Phone(Required)Doctor's Email(Required) Do you belong to a Medical Aid?(Required) Yes No Medical Aid provider(Required)Medical Aid plan(Required)Treatment commencement date(Required) DD slash MM slash YYYY Current fertility procedure(Required) AI IVF ICSI GIFT Donor Egg Donor Sperm Surrogacy Previous Fertility HistoryHave you had previous fertility treatment?(Required) Yes No If yes, approximately when?(Required)Previous procedures (please list)Approximate cost of previous treatment (ZAR) ChildrenDo you have children?(Required) Yes No Number of childrenPlease enter a number from 1 to 10.Are any of your children adopted? Yes No Ages of childrenAdditional Information & DeclarationsIs there anything else you would like us to know?Declaration of Accuracy(Required) The Wife declares the information provided is true and correct. The Husband declares the information provided is true and correct. Would you like to participate in the Ohel Sarala initiative?(Required) Yes No Privacy & POPIA Consent(Required) I have read the Privacy Policy and consent to Malka Ella processing the personal information in this application. Malka Ella collects this information solely to assess and administer your application. See our Privacy Policy for how we handle, store and retain your personal information.
