Join LBMFT - Membership Application

Mandatory Registration Notice: Please fill this form completely in BLOCK CAPITALS. Both primary and joint applicants must affix a recent passport-sized photograph and provide copies of photo ID and address verification documents. Unverified profiles cannot be processed.

Full 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

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

Full Name

Surname

Relationship

Spouse / Partner

Date of Birth

Gender

Male Female

Mobile No

ID / Passport No

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

Emergency Contact

Name

Relationship

Mobile No

Please list all dependants living permanently at the same address. Maximum 4 dependants.

No.	Full Name (Block Capitals)	Date of Birth	Gender	Relationship

Medical Declaration: Applicants are required to declare any serious pre-existing medical conditions at the time of joining, in accordance with our membership policy.

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

YES NO

Membership Tier Selection

Membership Type

Single Couple Family Membership Lifetime

Age Category

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

Document Checklist

Please confirm which documents you are submitting with this application.

Recent Passport Photos affixed on Page 1 Photo ID Proof Luton Address Proof

Please configure your permanent standing order or process online bank transfers using the verified account structure below. Remember to append your Full Name as the reference text.

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 allocations 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