Reg form – SXBC-OBA

Full Name

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Office Address

Date of Birth:

01-01-2000

School Admission Date

School Leaving Date:

Telephone NO

Office Telephone NO

Email Address

Profession

Type of MembershipAnnually (1000/=)10 Year Membership (5000/=)

Upload [ Bank Slip/online transaction receipt]

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BANK DETAILS

Account Name: Past Pupils’ Association

Account Number: 020010007965

Bank: Hatton National Bank PLC

Branch: Mannar

SWIFT CODE: HBLILKLX