Application Form for Elderly People in the Community Who Want to Learn English and Have Never Been

Taught English. This form includes the payment details for their classes, T-shirt and cap, ID card, polo,
and 2 English books for new learners. Please design the payment structure for each of the materials
listed above.

Name: _______________________

Age: ________________________

Address: _____________________

Contact Number: ______________

Email: _______________________

Please tick the appropriate box:

☐ Male

☐ Female

☐ I have never been taught English before.

☐ I have some basic knowledge of English.

Payment Details:

1. Classes: SLE_______ (Please specify the duration of the classes, e.g., per month, per session, etc.)

2. T-shirt and Cap: SLE_______ (Please specify the size required: S, M, L, XL)

3. ID Card: SLE_______
4. Polo: SLE_______ (Please specify the size required: S, M, L, XL)

5. English Books for New Learners: SLE_______ (Please specify the number of books required)

Total Payment: SLE_______

Payment Method:

☐ Cash

☐ Cheque

☐ Online Transfer

Please make the payment to the following account:

Account Name: _______________________

Account Number: _____________________

Please note that the payment must be made in full before the commencement of the classes.

By signing below, I confirm that the information provided above is true and accurate to the best of my
knowledge.

Signature: _______________________

Date: ___________________________