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WITH THE NAME ALLAH, THEM MERCIFUL BENEFACTOR, THE MERCIFUL REDEEMER Declaration of conversion to Islam Date _______________________ To whom this may concern, This is to certify that I,_________________________________________________, have publicly declared that: “Nothing deserves worship except Allah t’ala and Prophet Muhammad is His Messenger”. Signature of Pilgrim: _____________________________________________________ I ___________________________________________________ (Imam/Representative of the Islamic Center, here by declare that Brother / Sister converted to Islam. They are eligible to perform the Hajj /Umrah. For further information, please contact the undersigned. Sincerely, Imam Signature:_______________________________________________________________