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Personal Details

First Name

Last Name

NIC

Address

Date of Birth

E-mail Address

Phone Number

Mobile Number

WhatsApp number

Workplace Details

Workplace Name

Workplace Address

Office Phone Number

Profession

Qualifications

Year of school leaving

SSCOBA Life Membership Number

Lifetime Membership fee of SSCOBMA is Rs 1,000/-
Deposit cash, bank transfer or cheque deposit to:
Account Name: NAME
Bank: BANK NAME
Branch: PANADURA
Account No: 123456789

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