Qaim Member Registration – Qaim Foundation

FUNERAL AND MEMBERSHIP FORM

Username

Password

Confirm Password

Name of Applicant

Father's Name

Contact No

Date of Birth

E-mail Address

Postal Address

Overseas Address

FAMILY MEMBERS DETAIL:

Full Name

Date of Birth

Relationship with Main Member

Reg. Date

Add another Family Member

Full Name

Date of Birth

Relationship with Main Member

Reg. Date

Add another Family Member

Full Name

Date of Birth

Relationship with Main Member

Reg. Date

Add another Family Member

Full Name

Date of Birth

Relationship with Main Member

Reg. Date

Add another Family Member

Full Name

Date of Birth

Relationship with Main Member

Reg. Date

Add another Family Member

Full Name

Date of Birth

Relationship with Main Member

Reg. Date

Emergency Contact in Australia

Name

Relationship

Contact No

Address

Emergency Contact in Overseas

Name

Relationship

Contact No

Address

Beneficiary Detail

Name

Relationship

Contact No

Address

Funeral Fund Fee

MALE/FEMALE AGE 13 AND OVER IS	$500
MALE/FEMALE AGE 12 AND UNDER IS	$250

Membership Annual Fee

MALE 18 OR OVER	$200
FEMALE 18 OR OVER	$100
KIDS 17 OR UNDER	$50

Show Terms

I declare that the information provided in this form is correct to the best of my knowledge. I also declare that I will abide by the QFA constitution. I will keep the QFA aware of any changes to the information provided in this form. The QFA will protect the members personal details and under Privacy Act of 1988.

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FUNERAL AND MEMBERSHIP FORM

FAMILY MEMBERS DETAIL:

Emergency Contact in Australia

Emergency Contact in Overseas

Beneficiary Detail

Funeral Fund Fee

Membership Annual Fee

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