Membership Application

Complete the online application. The system will place your information directly onto the original SLPTA form.

Original 3-page form preserved

1. Personal Details

Membership Number Full Name Name With Initials NIC / Passport Number Date Of Birth Mobile Number WhatsApp Number Email Address

Residential Address

2. Business Information

Business / Company Name Business Registration Number District Years of Experience

Business Address

Main Business Activities

Photocopier Rental Photocopier Sales Repair and Maintenance Spare-parts sale Toner and Consumables

Other Business Activity Copier Brands Serviced

Number of Employees

Details of Employees Facebook Page / Website

3. Membership Documents

Applicant Photograph Reference from an existing member (if required) Income Tax No. Application Date

4. Membership Declaration

I certify that the information provided is accurate. I agree to follow the constitution, rules, professional standards and decisions of the Sri Lanka Photocopier Rental and Service Providers Association.

Applicant Signature