Parish Register (DWMPR1)

(Revised July 2015)

DIOCESE OF WEST MALAYSIA

APPLICATION FOR ENROLMENT ON THE PARISH REGISTER
DECLARATION

(Please fill in BLOCK LETTERS OR TYPE. Names should be according to MYKAD / PASSPORT.)
I, ____________________________________________________________________________
wish to apply for enrolment for myself / my son / my daughter / my ward on the Parish Register of the
Church of ________________________________________________________________________
in the Parish / Missionary District of ____________________________________________________

1. I am / He / She is a baptised member of the Anglican Church and does not belong to any
religious body which is not in communion with it.
2. I am / He / She worships regularly / attends Sunday school at _________________________
_________________________________________Church in this Parish / Missionary District.
3. So far as I am aware, my / his / her name is not included in the Parish Register or in any other
Parish / Missionary District in this Diocese.
4. I / His / her personal particulars are:
Name: ____________________________________________________________________
Date of Birth __________________ MYKAD / MYKID / Passport No:
____________________
Baptism Date: _____________________ Place:
____________________________________
Residence Address: __________________________________________________________
__________________________________________________________________________
5. My / Parent’s Contact:
Telephone: __________________________ (H) _______________________________(H/P)
Email Address: ____________________________________________________________

Date: _____________________ __________________________________________

Signature of Applicant / Parent

For Official Use

Application Approved and entered into Parish Register on ___________________________
Application no Approved for the following reasons
__________________________________

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_______________________________________________________
Signature and Name of Vicar

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