Ordinary/Extra-Ordinary …

1 Application for Membership Applicant s Declaration / / / I, , hereby apply as an Ordinary / Associate / ( Name of Applicant ) Extra-Ordinary ( Ordinary ) / Visiting Member of Japanese Association and agree to abide by the rules and regulations laid down by Japanese Association after the approval of my membership by the General Committee. I consent to allow the Japanese Association to use and disclose my Personal Data in this application form for all my membership related matters, activities and events, correspondences and communications with the Association in any form or media.

2 Signature of Applicant / Date / FOR OFFICE USE ONLY (Admission : ) The Japanese Association, Singapore 120 Adam Road, Singapore 289899 Tel : 64680066 Fax : 64696958 (General Office) 64671430 (Front Office) Membership ApplicationTemp. M'ship CardComputer EntryNomi ne e /Non-Nomi ne eInterview Date/Time Receipt No: Bank/Cheque No: Receipt No:Deposit $Cash / ChequeHandled by:Remarks:Entrance Fee $Ordi nary/Extra-Ordi nary (Ordi nary)/A s s oci ate /Honorary/Vi s i ti ng Yes / No Yes (# ) / NoCash / ChequeBank/Cheque No:Bank:Cheque No Bank:Cheque No Particulars of Applicant Applicant s Surname (Mr / Mrs / Miss / Mdm / Dr) First Name or / and Christian Name Chinese Characters (if any) Sex: Male / Female : Marital Status: Married / Single / Others Passport / IC No.

3 / IC Nationality Race: Japanese Chinese Malay Indian Others Date of Birth: Place of Birth Age Designation Name of Company Address of Company Singapore Tel No.: Fax No.: Residential Address Singapore Tel No.: Fax No.: H/P No. Vehicle Nos. 1) IU 2) IU E-mail Address 1 E 1 Special Skills Hobbies Qualifications/License / Membership of Other Club if any Public Commendation if any Criminal Records if any Responsible Position held in any Public Body if any Please Provide 2 Photographs 2 1 1 ( ) Particulars of Immediate Family Members of the Applicant i ) SPOUSE Surname ( Mr / Mrs / Mdm / Dr )

4 First Name or / and Christian Name Chinese Characters (if any) SIGNATURE Passport / IC No. Occupation H/P No. / IC Nationality Race: Japanese Chinese Malay Indian Others Date of Birth: Age Place of Birth Special Skills Hobbies Qualifications/License / i i ) Applicant s CHILDREN (under 25 years of age) & PARENTS 25 Full Name Chinese Characters Relationship to Applicant Date of Birth Signature Children 12 years old & above are required to sign and submit IC-size photographs 12 Please Provide 2 Photographs 2 1 1 ( ) Please Provide 2 Photographs 2 1 1 ( )

5 Please Provide 2 Photographs 2 1 1 ( ) Please Provide 2 Photographs 2 1 1 ( ) Please Provide 2 Photographs 2 1 1 ( ) E-mail Address 2 E 2 APPLICANT S DECLARATION I hereby declare that particulars given herein are true and correct and accept any responsibilities held by my dependents. Signature of Applicant / Date / ** Recommendation and Particulars of Proposer and Seconder (who must be Ordinary Member) We hereby recommend the herein-mentioned person to be a member of The Japanese Association, Singapore.

6 PROPOSER SECONDER Membership No. Name (Romanised) Name of Company Signature Date / 1 12 24 **

7 21 $ / 21 $1, +GST $ / The Japanese Association, Singapore $ +GST / $ +GST $ +GST$ +GST / $ +GST* GIRO 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 SS04 AV01 JS02 QB01 SS05 AW01

8 JT01 QB02 ST01 AW02 JT02 QD01 ST02 JT03 QL01 ST03 HB01 QN01 SV01 HB02 OB01 QN02 SW01 HC01 OC01 QP01 SW02 HC02 OC02 QT01 SY01 HD01 OC03 QT02 HD02 OC04 HE01 OC05 SA01 AB01 HJ01 OC06 SA02 AC01 HK01 OC07 SB01 AD01 HL01 OC08 SB02 AD02 HP01 OC09 SB03 AE01 HP02 OC10 SB04 AF01 HS01 OC11 SB05 AF02 HW01 OC12 SC01 AG01 OF01 SF01 AH01 JB01 OF02 SG01 AI01 JF01 OI01 SH01 AJ01 JH01 OK01 SI01 AM01 JH02 OM01 SJ01 AM02 JJ01 OM02 SJ02 AO01 JJ02 OR01 SK01 AP01 JK01 OS01

9 SK02 AP02 JK02 OS02 SR01 AP03 JN01 OT01 SS01 AS01 JO01 SS02 AS02 JR01 SS03 AS03 JS01 Nomination of Corporate Nominee Corporate Recommendation I, (Name of corporate authorised person ) (Designation ) of hereby nominate (Corporate Name / Membership No. / ) ,employee of this company to be a (Name of Nominee ) Ordinary / Associate Member of The Japanese Association, Singapore. On behalf of the / company, I hereby undertake to provide guidance to the nominated member to be a good member who observes and abides by the rules and regulations of the Japanese Association.

10 To charge Building Maintenance Fund for Individual Contribution of the above named nominee to: ( ) include in Corporate monthly invoice ( ) include in nominee monthly invoice Please indicate ( )for your selection. Signature of Corporate Authorised person / Corporate Stamp* / Contact No. Date Submit Original Copy to Japanese Association, Singapore APPLICATION FORM FOR INTERBANK GIRO PART 1 : FOR APPLICANT S COMPLETION ( fill in the spaces indicated with ) (a)I / We hereby instruct you to process the BO s instructions to debit my / our account.