Pakistan Welfare Association

Burton Upon Trent | April 2024

Application Form

Full Name

Address

Town

Email Address

Date of Birth

Place of Birth

Post Code

Mobile No.

Dependant Children

Please list below ALL the dependant children in your household who are under the age of 18, or 18-22 and in full-time education.

Agreement

I/We Hereby confirm the above details provided are genuine and valid. I/We also understand that submitting an application or making payment does not obligate PWA Burton On Trent to grant Membership. Membership will only be approved once all criteria are met, Supporting documents presented, Payment made in Full and approval is informed by the Management of PWA Burton On Trent. I/We understand and agree that it is my/our duty and responsibility to notify PWA Burton On Trent of ALL changes in circumstance in relation to myself/ALL those under this Membership, at my/our earliest convenience.

Main Applicant Name

Main Applicant Signature

Date

Spouse Name

Spouse Signature

Date