Na Min
Pian Ni, Kha leh Kum
Pa Min
Kipatna Saptuam
Member Hihna (A nuai a option te, na hih na bangbang 'TICK' mark in.) PM - (Primary Member: Baptisma tang nailou leh Toupa ankuang siangthou um nailou)JCM - (Junior Communicant Member: Baptisma tangkhinsa, Toupa ankuang siangthou um khinsa, upat kum 18 nuailamte)FCM - (Full Communicant Member: Baptisma tangkhinsa, Toupa ankuang siangthou um khinsa, upat kum 18 tunglamte)AM - (Associate Member: EBCC member hilou, hilehle saptuam ngaina a hong kikhawm zel te.)KM - (Khualtaam Member)
Baptima Tangsaktu
Baptisma Tan Ni
Saptuam Dan A Kiten Ni
Saptuam A Kizatna
Sawm A Khat Pia / Pelou PiaPelou
Family & Sepna neite a diing:
Local Address / Kingakna mun
Permanent Address
Contact No.
Home Contact No.
Siamsinte a diing:
Local Guradian' Min & Address
Siamsinna School / College
Form Pelluttu Min
Your Email
Form Piaklut Ni:
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