- CANAANCITY HOUSING SCHEME LAND ALLOCATION FORM
-
:: Personal Data ::
Surname
:
*
Othernames
:
*
Title
:
Select Passport:
:
*
Date of Birth :
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
January
February
March
April
May
June
July
August
September
October
November
December
(Day, Month and Year)
Gender
:
Male
Female
Marital Status
:
Single
Married
Seperated
Widowed
Nationality
:
*
Country of Domicile
:
Afghanistan
Albania, Peoples Socialist Republic of
Algeria, Peoples Democratic Republic of
American Samoa
Andorra, Principality of
Angola, Republic of
Anguilla
Antarctica (the territory South of 60 deg S)
Antigua and Barbuda
Argentina, Argentine Republic
Armenia
Aruba
Australia, Commonwealth of
Austria, Republic of
Azerbaijan, Republic of
Bahamas, Commonwealth of the
Bahrain, Kingdom of
Bangladesh, Peoples Republic of
Barbados
Belarus
Belgium, Kingdom of
Belize
Benin, Peoples Republic of
Bermuda
Bhutan, Kingdom of
Bolivia, Republic of
Bosnia and Herzegovina
Botswana, Republic of
Bouvet Island (Bouvetoya)
Brazil, Federative Republic of
British Indian Ocean Territory (Chagos Archipelago)
British Virgin Islands
Brunei Darussalam
Bulgaria, Peoples Republic of
Burkina Faso
Burundi, Republic of
Cambodia, Kingdom of
Cameroon, United Republic of
Canada
Cape Verde, Republic of
Cayman Islands
Central African Republic
Chad, Republic of
Chile, Republic of
China, Peoples Republic of
Christmas Island
Cocos (Keeling) Islands
Colombia, Republic of
Comoros, Federal and Islamic Republic of
Congo, Democratic Republic of
Congo, Peoples Republic of
Cook Islands
Costa Rica, Republic of
Cote D'Ivoire, Ivory Coast, Republic of the
Cuba, Republic of
Cyprus, Republic of
Czech Republic
Denmark, Kingdom of
Djibouti, Republic of
Dominica, Commonwealth of
Dominican Republic
Timor-Leste
Ecuador, Republic of
Egypt, Arab Republic of
El Salvador, Republic of
Equatorial Guinea, Republic of
Eritrea
Estonia
Ethiopia
Faeroe Islands
Falkland Islands (Malvinas)
Fiji, Republic of the Fiji Islands
Finland, Republic of
France, French Republic
French Guiana
French Polynesia
French Southern Territories
Gabon, Gabonese Republic
Gambia, Republic of the
Georgia
Germany
Ghana, Republic of
Gibraltar
Greece, Hellenic Republic
Greenland
Grenada
Guadaloupe
Guam
Guatemala, Republic of
Guinea, Revolutionary Peoples Rep'c of
Guinea-Bissau, Republic of
Guyana, Republic of
Haiti, Republic of
Heard and McDonald Islands
Holy See (Vatican City State)
Honduras, Republic of
Hong Kong, Special Administrative Region of China
Hrvatska (Croatia)
Hungary, Hungarian Peoples Republic
Iceland, Republic of
India, Republic of
Indonesia, Republic of
Iran, Islamic Republic of
Iraq, Republic of
Ireland
Israel, State of
Italy, Italian Republic
Jamaica
Japan
Jordan, Hashemite Kingdom of
Kazakhstan, Republic of
Kenya, Republic of
Kiribati, Republic of
Korea, Democratic Peoples Republic of
Korea, Republic of
Kuwait, State of
Kyrgyz Republic
Lao Peoples Democratic Republic
Latvia
Lebanon, Lebanese Republic
Lesotho, Kingdom of
Liberia, Republic of
Libyan Arab Jamahiriya
Liechtenstein, Principality of
Lithuania
Luxembourg, Grand Duchy of
Macao, Special Administrative Region of China
Macedonia, the former Yugoslav Republic of
Madagascar, Republic of
Malawi, Republic of
Malaysia
Maldives, Republic of
Mali, Republic of
Malta, Republic of
Marshall Islands
Martinique
Mauritania, Islamic Republic of
Mauritius
Mayotte
Mexico, United Mexican States
Micronesia, Federated States of
Moldova, Republic of
Monaco, Principality of
Mongolia, Mongolian Peoples Republic
Montserrat
Morocco, Kingdom of
Mozambique, Peoples Republic of
Myanmar
Namibia
Nauru, Republic of
Nepal, Kingdom of
Netherlands Antilles
Netherlands, Kingdom of the
New Caledonia
New Zealand
Nicaragua, Republic of
Niger, Republic of the
Nigeria, Federal Republic of
Niue, Republic of
Norfolk Island
Northern Mariana Islands
Norway, Kingdom of
Oman, Sultanate of
Pakistan, Islamic Republic of
Palau
Palestinian Territory, Occupied
Panama, Republic of
Papua New Guinea
Paraguay, Republic of
Peru, Republic of
Philippines, Republic of the
Pitcairn Island
Poland, Polish Peoples Republic
Portugal, Portuguese Republic
Puerto Rico
Qatar, State of
Reunion
Romania, Socialist Republic of
Russian Federation
Rwanda, Rwandese Republic
St. Helena
St. Kitts and Nevis
St. Lucia
St. Pierre and Miquelon
St. Vincent and the Grenadines
Samoa, Independent State of
San Marino, Republic of
Sao Tome and Principe, Democratic Republic of
Saudi Arabia, Kingdom of
Senegal, Republic of
Seychelles, Republic of
Sierra Leone, Republic of
Singapore, Republic of
Slovakia (Slovak Republic)
Slovenia
Solomon Islands
Somalia, Somali Republic
South Africa, Republic of
South Georgia and the South Sandwich Islands
Spain, Spanish State
Sri Lanka, Democratic Socialist Republic of
Sudan, Democratic Republic of the
Suriname, Republic of
Svalbard & Jan Mayen Islands
Swaziland, Kingdom of
Sweden, Kingdom of
Switzerland, Swiss Confederation
Syrian Arab Republic
Taiwan, Province of China
Tajikistan
Tanzania, United Republic of
Thailand, Kingdom of
Togo, Togolese Republic
Tokelau (Tokelau Islands)
Tonga, Kingdom of
Trinidad and Tobago, Republic of
Tunisia, Republic of
Turkey, Republic of
Turkmenistan
Turks and Caicos Islands
Tuvalu
US Virgin Islands
Uganda, Republic of
Ukraine
United Arab Emirates
United Kingdom of Great Britain & N. Ireland
United States Minor Outlying Islands
United States of America
Uruguay, Eastern Republic of
Uzbekistan
Vanuatu
Venezuela, Bolivarian Republic of
Viet Nam, Socialist Republic of
Wallis and Futuna Islands
Address
:
*
Zip/Postal Code
:
* NA if non
Email
:
*
Telephone No.
(landline) :
Mobile Phone no.
:
*
Occupation
:
:: Church profile::
Year joined Winners
:
(if a Winner)
Where
:
Present Local Church
:
*
Service Group
:
Name of Church/Ministry
:
(if not a Winners Member)
Position/Status in Church
:
Address of Church/Ministry
:
Zip/Postal Code
:
* NA if non
:: Referee Data ::
Name of Next of Kin
:
*
Relationship
:
*
Occupation
:
*
Address
:
*
Zip/Postal Code
:
* NA if non
Telephone No. (landline)
:
Mobile Phone Number
:
*
Email
:
Name of Referee I
:
*
Relationship
:
*
Occupation
:
*
Address
:
*
Zip/Postal Code
:
* NA if non
Telephone No. (landline)
:
Mobile Phone Number
:
*
Email
:
Name of Referee II
:
*
Relationship
:
*
Occupation
:
*
Address
:
*
Zip/Postal Code
:
* NA if non
Telephone No. (landline)
:
Mobile Phone Number
:
*
Email
:
:: declaration ::
I
hereby declare that all the above information are given in truth and verity. Should any of the information be found to be false I hold myself resposible for the implication, so help me God.
Please accept the terms to submit form
Decline
Accept