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Membership Form 3
Membership Form 3
Membership Form 3
முழு பபயர்
1 FULL NAME
அடையாள அை்டை
2 எண்
IC NUM
வீை்டின் முகவரி
3 Address (Hse)
போடைதபசி எண்
4 Contact Number
போடைதபசி எண்
5 Email Address
மிை்ைாண்ை்ஸ்
Yes ( ) No ( )
6 குடியிருப் பு
Residence Midlands
7 பாலினம்
Gender Male ( ) Female ( )
8 பிறந் ே தேதி
Date Of Birth
9 தேசியம்
Nationality
பணியாளர் முகவரி
10 Employee Add
11 அலுவைக எண்
Office Number
- When submitting the form, please attach ic photostat and photo passport size.
- The applicant agree to abide by the rules & regulation and must follow the directives of Sri
Mahamariaaman Devasthanam.
- Application will be terminated IMMEDIATELY if against the regulation of the devasthanam
and with unacceptable behavior ( discipline problem ).
- The membership’s first priority will be to Midlands born applicant.
- Applicant must be at least of eighteen (18) years of age and nationality of Malaysian.
Member’ Aggreement:
I promise that the information about me / participant in this form is correct.I have read and understand
everthing in this foem.Executed as a deed.
___________________________ _________________________
(SIGNATURE OF APPLICANTS) (SIGNATURE OF WITHNESS)
By committee incharge of membership
Name : Name :
Date : Date :
Verify by:
-------------------------------------------- __________________________
(SIGNATURE OF SECRETARY) (SIGNATURE OF CHAIRMAN)
Name : Name :
Date : Date :