PERSONAL PARTICULARS / BUTIR-BUTIR DIRI

Your Name (as per NRIC / Passport) :

New NRIC No. / No. Kad Pengenalan Baru :

Passport / Military ID / Police No. Passport / No. Tentera / Polis :

Nationality / Kewarganegaraan:
MalaysianOthers / Lain-lain:

Date of Birth / Tarikh Lahir (dd/mm/yy):

CONTACT INFORMATION / MAKLUMAT UNTUK DIHUBUNGI

Home / Rumah No.:

Office / Pejabat:

E-mail Address / Alamat E-mel:

Mobile/ Tel.Bimbit:

Mailing Address / Alamat Surat - menyurat:

City:

Postcode / Poskod:

State / Negeri:

Country / Negara:

MANDATORY FIELD / RUANGAN WAJIB DIISI - Parents Information (for application below 18 years old)

Parent's Name / Nama Ibu Bapa:

Tel / Hp no.:

Email Address:

PAYMENT INFORMATION [CASH] - if cheque payable to Klang City Badminton Club Sdn Bhd

Proposer(NAME)

Bank A/C no.:

Bank Name:

Name of Applicant:

Date: