PERTUBUHAN KEBAJIKAN SRI NYANANANDA MALAYSIA

ENTRY FORM FOR 2ND NATIONAL DAY FUTSAL TOURNAMENT

2015
TEAM NAME

BARATHI

CONTACT PERSON :

K.ARVIND

CONTACT NUMBER :

0134095103

BIL

NAME

BC/IC/PASSPORT NO.

1
2

PIRAVIIN A/L KESAVAN

030706080805

PUGENTHIRAN A/L GANESON

030616081003

SHASHITHARAN A/L RAVI

030716080913

KEVIN RAJ A/L GONVIDASAMY

041023101703

VIJENDRAN A/L VASU

051021080901

CHAARAAN A/L BALU

040928020997

SIVANESH A/L SUNTIRAN

040128080959

JEEVAN A/L RAJUMUNIANDI

031225080673

In consideration of the organizer accepting this entry and registration to

participate in the tournament, I hereby for myself, my team members, our heirs
and administrators waive and release any and all rights or claims to damages we
may have against the organizer holding this tournament for any and all injuries,
death and invalidity and waive against all claims that may arise in consequence
of the above.
-------------------------------Manager
Signature
ACCOUNT
NUMBER

: 558060503019 (MAYBANK)

ACCOUNT HOLDER : PERTUBUHAN KEBAJIKAN SRI NYANANANDA

MALAYSIA

PRITHVARAJU
016-5445546

MURUGAN
016-9315631

TANESKUMAR
016-5463995

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