MEMBERSHIP APPLICATION FORM

Registration No.: ………………………....

1. SURNAME: ……………………………………………….... OTHER NAME: ………………………………….……………………….………………

2. DATE OF BIRTH: ………………………………………….. PLACE OF BIRTH: ……………………………….……………………………………..

3. RESIDENTIAL ADDRESS: ……………………………….………………………………. MOBILE NO.: …………………………………………………..

4. EDUCATIONAL BACKGROUND: ……………………………….…………………… YEAR COMPLETED……………………………….

5. POSTAL ADDRESS: ……………………………….………………………………. REGION OF ORIGIN: …………………………………………

6. NATIONALITY: ……………………………….………………………………. TOWN OF ORIGIN: ……………………………………………

7. DRIVING DOCUMENT: ……………………………….…………………. PLACE OBTAINED: ……………………………………….….

8. OCCUPATION: ……………………………….………………………………. EMAIL ADDRESS: ………………………………………………………….

9. MARITAL STATUS: SINGLE MARRIED SEX: M F

10. LANGUAGES SPOKEN: …………………………………………….…………………………………………….……………………………………………………..

11. DECLARATION: I …………………………………………….……………………………………………. Declare that all the information provided

and attachments to this form are authentic and correct in every detail. i understand that any forgery renders me liable

to prosecution.

SIGNATURE: …………………………………………….……………………………………………. DATE: ………………………………………………….

12. PROVISION OF VOTER ID NUMBER: …………………………………………….…………………………………………….……………………….………

OFFICE USE

13. NAME OF THE SECRETARY OF THE ASSOCIATION: ………………………………………………………………………………………………………..

SIGNATURE: …………………………………………………………………… DATE……………………………………………………………….....................