http://arakanrohingyacouncil.blogspot.

com

arc.council.my@gmail.com

Tel & Fax: +603-42854711

tzGJU0ifcGifhavQmufvTm Membership Application Form

Membership Reg. No.:

Office use only

toif;0ifrSwfyHkwiftrSwf?

Hk;oHk;om

Name
trnf

rif tjym^trnf; udkomoHk;yg/Write in blue/black ink only.

rMumao;cifudkuful;xm;aom yufpfyk'f"gwfyHk(3)yHkwJGwifyg/
Attach with three (3) recently taken Passport photos.

Gender
vdif

Date of birth
arG;ou&mZf

Male
usm;

Age
Y jynfhNyD;touf

Fathers name
tztrnf

Female
r
Years
ESpf

Mothers name
trdtrnf

Place of birth
arG;zGm;&ma'o

Vil.,
&yfuGuf?

Education
ynmt&nftcsif;

Town,

State.

NrdKUe,f?

jynfe,f^wdkif;

Occupation
tvkyftudkif

Current address
vufSdae&yfvdyfpm
Contact No.

E-mail
FAX No.

qufoG,f&efzkef;eHygwf

Marital status
tdrfaxmifzuf

Single
rSd

Name of Spouse
cifyGef;^ZeD; trnf

Other memberships

Married
Sd

tzGJY0if tzGJYrsm;

(D/S of ) (b)
)vlrsKd;?Citizen: (

[Race: (

Date of arrival in Malaysia

rav;Sm;a&muf&ufpGJ

om;^orD;trnf
arG;zGm;&ma'o arG;ou&mZf
Name of Son/Daughter Place of Birth Date of Birth

)EdkifiHom;]

UNHCR ref#
UNHCR eHygwf

om;^orD;trnf
arG;zGm;&ma'o arG;ou&mZf
Name of Son/Daughter Place of Birth Date of Birth

I hereby declare, after thoroughly reading and understanding, that I agree with all the terms and conditions stated in the Rules and Regulations
of Arakan Rohingya Council on my own free-will .

tm&umef

dk[if*smaumifpD\

zGJYpnf;yHktajccHpnf;rsOf;

wGifa&;om;xm;aom

tcsuftvufrsm;tm;vHk;udk

zwfI

em;vnfNyD; udk,foabmeJYudk,f vGwfvyfpGmjzifh oabmwlnDaMumif; atmufwGifvufrSwfa&;xdk;ygonf/

Office Use Only:Hk;oHk;om

Approved
cGifhjyKonf

Not Approved
cGifhrjyK

Left finger
print
vuf0JvufaAG

Applicants Signature
avQmufxm;ol\vufrSwf

http://arakanrohingyacouncil.blogspot.com

arc.council.my@gmail.com

Tel & Fax: +603-42854711

tzGJU0ifcGifhavQmufvTm Membership Application Form

Membership Reg. No.:

Office use only

toif;0ifrSwfyHkwiftrSwf?

Hk;oHk;om

Name
trnf

rif tjym^trnf; udkomoHk;yg/Write in blue/black ink only.

rMumao;cifudkuful;xm;aom yufpfyk'f"gwfyHk(3)yHkwJGwifyg/
Attach with three (3) recently taken Passport photos.

Gender
vdif

Date of birth
arG;ou&mZf

Male
usm;

Age
Y jynfhNyD;touf

Fathers name
tztrnf

Female
r
Years
ESpf

Mothers name
trdtrnf

Place of birth
arG;zGm;&ma'o

Vil.,
&yfuGuf?

Education
ynmt&nftcsif;

Town,

State.

NrdKUe,f?

jynfe,f^wdkif;

Occupation
tvkyftudkif

Current address
vufSdae&yfvdyfpm
Contact No.

E-mail
FAX No.

qufoG,f&efzkef;eHygwf

Marital status
tdrfaxmifzuf

Single
rSd

Name of Spouse
cifyGef;^ZeD; trnf

Other memberships

Married
Sd

tzGJY0if tzGJYrsm;

(D/S of ) (b)
)vlrsKd;?Citizen: (

[Race: (

Date of arrival in Malaysia

rav;Sm;a&muf&ufpGJ

om;^orD;trnf
arG;zGm;&ma'o arG;ou&mZf
Name of Son/Daughter Place of Birth Date of Birth

)EdkifiHom;]

UNHCR ref#
UNHCR eHygwf

om;^orD;trnf
arG;zGm;&ma'o arG;ou&mZf
Name of Son/Daughter Place of Birth Date of Birth

I hereby declare, after thoroughly reading and understanding, that I agree with all the terms and conditions stated in the Rules and Regulations
of Arakan Rohingya Council on my own free-will .

tm&umef

dk[if*smaumifpD\

zGJYpnf;yHktajccHpnf;rsOf;

wGifa&;om;xm;aom

tcsuftvufrsm;tm;vHk;udk

zwfI

em;vnfNyD; udk,foabmeJYudk,f vGwfvyfpGmjzifh oabmwlnDaMumif; atmufwGifvufrSwfa&;xdk;ygonf/

Office Use Only:Hk;oHk;om

Approved
cGifhjyKonf

Not Approved
cGifhrjyK

Left finger
print
vuf0JvufaAG

Applicants Signature
avQmufxm;ol\vufrSwf