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UMPIRE’S REGISTRATION FORM (Please attach 2 passport si ze coloured photo) UMPIRE’S PERSONAL DETAILS 1. Name in Full : A L V I N A D A T H A N A K J U A 2. Identity Card No :9 2 ! 1 9 - 1 " - # $ # # ". A%e: 2" &ear' old !. ())u*ation: +TUD,NT #. -ailin% Addre'': (latest) U-AH NUIN/0 +UN/AI -A AI o't Code: 9 3 +tate:+A A4AK . ,mail Add: dat5)y%dia6%mail.)om 3. Conta)t No: 1 3 # 3 9 1 2 # Tick ( ) in appropriate column: Um*ire +tatu' : FIH UL /red 1 4orld Cu* 7 (lim*i) (at present) Cla'' 1 Cla'' 2 8 Cla'' " &ear *a''ed T5eory , am: 21! 7 ot5 Cate%ory I0 5ere;y a%ree t5at all in<ormation %i=en i' true. I am a>are t5at -HCUC at any time '5ould it ;e <ound any <al'e detail' 5a=e ;een %i=en. @ ................................................................ Date:.....................22. .21!.... Um*ireB' +i%nature ENDORSED BY STATE UMPIRES’ BOARD APPROVED BY MH UMPIRES’ OMMITTEE @ ................................................................ @ .................................. C5airman o< +tate Um*ire'B oard C5airman o< -HC Um*ire'B Committee Date : Date : I >ould li e to ;e in=ol=ed in 8 (utdoor Ho) ey 7 Indoor Ho) ey 1 STATE ASSOCIATI ON STAMP
