Join LBMFT - Membership Application

Important: All fields marked * are mandatory. Please ensure all information is accurate and complete. Misrepresentations may result in termination of membership and forfeiture of past contributions.

First Name

Surname

Marital Status

Date of Birth

Must be at least 18 years old.

Gender

Male Female

ID / Passport No

Address

Postcode

Town / City

Mobile No

Email Address

Primary Applicant Passport Photo Upload Photo No file chosen Upload recent passport-sized photo (JPEG/PNG, max 2MB)

Next of Kin

Full Name

Relationship

Phone Number

Email Address

Membership Tier Selection

Membership Type

Single Couple (Member + Spouse) Family (Member + Spouse + Dependants) Lifetime (£4,000 — Single only)

Age Category

Auto-set from your date of birth. Select Lifetime manually if desired.

Mandatory Documents Attached

Please confirm which documents you are submitting with this application.

Passport-sized photographs Photo ID (passport / driving licence) Proof of address (utility bill / bank statement)

First Name

Surname

Relationship

Spouse / Partner

Date of Birth

Gender

Male Female

ID / Passport No

Mobile No

Email Address

Spouse / Joint Applicant Photo Upload Photo No file chosen Upload recent passport-sized photo (JPEG/PNG, max 2MB)

Please list all unmarried dependant children living permanently at your address. Maximum 4 dependants.

No.	Full Name	Date of Birth	Gender	Relationship

Does any individual listed on this application profile suffer from a severe chronic or terminal illness?

NO YES — please provide details below

Bank Transfer Details

Account Name: Luton Bangladeshi Muslim Funeral Trust

Sort Code: 23-05-80

Account No: 57955104

Reference: Your full name

Payment Method

I/We formally declare that all parameters logged across this application are fully factual and precise. I/We recognize that LBMFT operates as a community mutual support infrastructure and is not a commercial insurance provider. Relief allocants remain subject to Executive Committee validation. Misrepresentations regarding residency boundaries within Luton or pre-existing diagnoses may terminate registration and forfeit past contributions.

I/We agree to the above declaration. This application cannot be submitted without this consent.

I consent to LBMFT storing and processing my personal data for the purpose of managing my membership and providing funeral trust services.

Date

Your application will be reviewed by our committee. You will receive a confirmation email once submitted.

Membership Application Form