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Membership Registration Form
KOOTHANALLUR ASSOCIATION
(UEN: S96SS0158A)
100 Jalan Sultan #09-06 Sultan Plaza
Singapore 199001
Tel : 6299 3677 | Fax : 6293 8959
E-mail : contact@koothanallur.sg | Website : www.koothanallur.sg
Photo
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Family Name
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Your Name
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Father’s Name
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NRIC/Passport No
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Date of Birth
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Sex
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Male
Female
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Nationality
Singaporean
Malaysian
Indian
Others
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Singapore PR?
Yes
No
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Marital Status
Single
Married
Divorced
Widowed
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Family Details :
Total No. of Family Members living in the same House
Parents
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Spouse (Husband/Wife)
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No. of Children (Not Married)
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Others (Brothers/ Sisters)
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Home Details :
Home Address
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Singapore
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Home Tel:
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Office Tel
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Your Email
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Mobile No
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Occupation/Title
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Company Name
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Company Address
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Singapore
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Hobbies
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Health Problems (if any):
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Emergency Contact Name
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Relationship
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Emergency Contact Tel No
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Parent’s Details:
Father’s Name:
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NRIC/Passport No:
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Mother’s Name:
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NRIC/Passport No:
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Spouse Details:
Spouse Name
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NRIC/Passport No :
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Date of Birth
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Children’s Details :
Name
M / F
NRIC / Birth Cert No
Date of Birth (D / M / Year)
1
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2
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3
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4
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I confirm and verify the above details are correct to my knowledge
I consent to joining Koothanallur Association. I have read and fully understood the Koothanallur Association’s Constitution. I will abide by the constitution and by-laws of the Koothanallur Association.
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