PTKS MEMBERSHIP APPLICATION FORM

PERSEKUTUAN KEBAJIKAN ISLAM TELOK KURAU, SINGAPURA

Membership Application Form
To the Honorary Secretary

PERSEKUTUAN KEBAJIKAN ISLAM TELOK KURAU SINGAPURA,

I am pleased to apply to be an associate member of this organisation. I am enclosing here with cash/paynow amounting to $50.00 as associate member registration fee, first month's fee, mawlid fund and a copy of the law book and membership card.

Once I have been officially accepted as a member of this Federation I will comply with the following matters:

1)    Obey and comply with all the laws and regulations of this Federation which are written in the Law Book and its amendments that will be made from time to time.

2)    Willing to pay my membership fee to the organisation

3)    Willing to donate to the reserve funds organised by the Federation.

4)    If there is a change of my particulars, I will immediately report to the organisation in regard to my residential address, whereas the organisation office may add or delete the names of my dependents and the names of nominees to update my membership records as per my request.

5)    Be prepared to provide photocopies of letters or documents (identification card, birth certificate, marriage certificate, etc.) as required by the organisation.

Here are my details and information as required by the organisation. I solemnly swear that all the information I entered on this form is true and authentic.

ATTENTION

a) Applicants to become members of this organisation must be between 21 years old and 65 years old. The applicant and all dependents of the applicant and nominee must be Singaporeans or permanent residents of Singapore who are Muslims.

b) The term child in the list of dependents is biological child, step-child and for adopted children, if it is necessary to show certificates or documents of adoption that are valid and recognised by the government, and all these dependents must be under the age of 21 and unmarried.

c) In the event of a member's passing, the coverage will include the ritual washing and shrouding (mandi and kafan), transportation of the deceased from home to pusara, the presence of an imam and the recitation of the talqin as well as the provision of a grass patch and a grave marker. Any other services required will be considered as additional and may incur separate charges. Terms & Conditions apply.
(1) REGISTRATION OF THE APPLICANT
Name as per NRIC*
IC No.*
Date of Birth*

DayMonthYear
Date
Address*

Street Address

Street Address 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.Format: (00000000).
Email*
example@example.com
IC front*

Cancelof
IC back*

Cancelof
(2) REGISTRATION OF SPOUSE
Spouse's Name as per NRIC
Spouse's IC No.
Spouse's Date of Birth

DayMonthYear
Date
Spouse's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Spouse's Phone Number
Please enter a valid phone number.Format: (00000000).
Spouse's Email
example@example.com
Marriage Certificate

Cancelof
(3) REGISTRATION OF BIOLOGICAL MOTHER/FATHER
Mother's Name
Mother's IC No.
Mother's Date of Birth

DayMonthYear
Date
Mother's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Father's Name
Father's IC No.
Father's Date of Birth

DayMonthYear
Date
Father's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
(4) REGISTRATION OF CHILDREN UNDER21 YEARS OLD AND NOT MARRIED
No. of Children Under 21 Years Old and Not Married

Children Under 21 Years Old and Not Married

Rows	Child's Name	Child's Date of Birth	Child's IC No.
1
2
3
4
5
6
7

(5) REGISTRATION OF TWO (2) NOMINEE
(1)Nominee's Name*
(1) Nominee's IC No.*
(1)Nominee's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
(1) Nominee's Phone Number*
Please enter a valid phone number.Format: (00000000).
(1) Nominee's Relationship*
(2) Nominee's Name*
(2) Nominee's IC No.*
(2) Nominee's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
(2) Nominee's Phone Number*
Please enter a valid phone number.Format: (00000000).
(2)Nominee's Relationship*
Reminder:

1) A member is only entitled to claim death benefits after officially becoming a member for 3 months from the date of association.

2) The organisaton has the right to see and demand photocopies of the evidence and documents required.

3) The organisation reserves the right to reject this application if there are false or untrue statements recorded on this form.
Signature*

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PERSEKUTUAN KEBAJIKAN ISLAM TELOK KURAU, SINGAPURA

(1) REGISTRATION OF THE APPLICANT

(2) REGISTRATION OF SPOUSE

(3) REGISTRATION OF BIOLOGICAL MOTHER/FATHER

(4) REGISTRATION OF CHILDREN UNDER21 YEARS OLD AND NOT MARRIED

(5) REGISTRATION OF TWO (2) NOMINEE