Member Name

P.F No

IC No(New)

Race Choose Race MALAY CHINESE INDIAN OTHERS

Member Type Choose Member Type Normal Member Associate Member

Employee No

Sex Choose Sex Male Female

Marital status Choose status Single Married Others

Date of Birth

Date of Join

Address

Postal Code

Date Promoted to Scope

Office Address

Personal E-Mail (Enter a Valid Email Id* )

Office E-Mail

Have you been a member of this union before?

Yes     No

Company name Choose company name NUJ

Newspaper Agency Choose Newspaper Agency Nanyang Siang Pau Branch (HQ) Nanyang Siang Pau Branch (Penang) Nanyang Siang Pau Branch (Perak) Nanyang Siang Pau Branch (Johor) Nanyang Siang Pau Branch (Melaka) Sin Chew Branch Kwong Wah Branc h STAR Branch Sun Branch New Straits Times Branch Associate Members

Proposed by : Name

PF No / Membership No

Seconded by : Name

PF No / Membership No

Decision on this application made at EXCO Meeting held on

Position

NP

No.Tel(R)

No.Tel(O)

No.H/P

Entrance Fee

Monthly Fee

Welfare Fund

Recommended By

Supported By

Designation Select HR ADMINISTRATOR CLEARK

Department Select HR MAINTENANCE

False Allegations Select Yes Not Yet

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Nominee Details

Name	Home Address	Age	Relationship	NRIC No

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Guardian Details

Name	Home Address	Age	Relationship	NRIC No
			Select FATHER MOTHER BROTHER SISTER GRAND FATHER GRAND MOTHER FATHER-IN-LAW MOTHER-IN-LAW BROTHER-IN-LAW SISTER-IN-LAW SON DAUGHTER SELF HUSBAND WIFE AUNTY FRIEND UNCLE NEPHEW COUSIN RELATIVE FIANCEE NIECE

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