APPLICATION FOR BLLS LIFE MEMBERSHIP
(To fill in the form, please use CAPITAL letters only)

Name:	 	
		
BLLS Membership No.	 
IC /FIN No.	
Registered on (mm/yyyy)		

Home Address		

Office Address		

Tele Home		Tele Mobile	 	
Email Address:		

I hereby declare that the above particulars given by me are trues and correct. If my Life Membership is approved, I shall pay* the fee of $300.00 within two weeks of approval. 

I shall also comply with the rules set out in the Constitution of the Bangla Language and Literary Society (Singapore) and notify the Society in case of any change of my address and/or particulars.

Date:	Signature:

For Official Use Only	
Date App Received		Payment Received		
Approved / Not Approved		
Date of Notification		
Date of Approval			

President / Secretary	Treasurer

This application form is not valid without original stamp of Bangla Language and Literary
Society (Singapore)

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