Application for Individual Membership

Fill in the form below and submit for membership committee review. Once the references are checked, our secretariat will be in touch with you for arranging the subscription payment. Once the payment is received you will be notified with the membership.

Membership category applied
OrdinaryLifeAssociateHonorary

Note: extent should be not less than 2 hectares to be eligible for Ordinary/Life membership).

Name of applicant

National Identity Card Number

Residential Address

Contact Numbers

Landline

Mobile

E-mail Address

If employed, place of Employment

Is the applicant the owner or lessee or spouse of owner

Address of the Estate

Extent of Estate

Acres

Rods

Perches

Grama Niladari Division

Coconut Development Officer (CDO) division

Coconut Cultivation Board Registration No

Divisional Secretariat division

Proposed by

Membership No.

NIC No.

Mob No.

Seconded by

Membership No.

NIC No.

Mob No.

Admission fee and total contribution

I declare that the foregoing information is correct. Any changes to the above information will be notified to CGASL immediately.