become a member

Here you can download the application as a Word file

ONTARIO SENIOR TAMILS BENEVOLENTASSOCIATION
EST. 2012. REG:NOT FOR PROFIT ORGANIZATION #1866873, ONTARIO, CANADA
ஒன்டாரியோமுது தமிழர் நலன்புரி ஆதாயமற்ற சங்கம் # 1866873
Mailing address: – OSTBA, PO. Box 48068 Dundas& Sheppard, Mississauga ON L5A 4G8
NEW AAPILICATION FORM FROM 2025 ONWARDS

APPLICATION FORM FOR MEMBERSHIP IN THE BENEVOLENT ASSOCIATION (OSTBA)

O.S.T.B சங்கத்தில் அங்கத்தினராக சேரும் விண்ணப்பப் பத்திரம்

O.S.T.B.A Membership ID (சங்க அங்கத்தினர்)

Applicant’s full Name (In BLOCK LETTERS)
Mr. Mrs. M/s (Please send copy of your ID and of the Beneficiaries along with the application)
01. First Name

02. Middle Name

03. Last Name

04. Gender

MaleFemale

05. Date of Birth

06. Address

07. Telephone

1. Land Phone

2. Cell Phone

08. Email

09. Name of the Seniors association in which you are a paid member & your membership no:

1. Association Name

2. Membership No

Membership number and full name of the recommending member from OSTBA Name of Member Recommending

10. Full name of the recommending member from OSTBA ( Mr.,Mrs.)

1. Membership number (Recommending member)

12. Citizen

YesNo

13. Permanent Resident (Only citizen and permanent residents could become as a member)

YesNo

14. I declare truly that I am free of any Terminal Illness as at date of acceptance of my application for membership in OSTBA Signature

15. The Fees applicable as per OSTBA constitution are as follows: (Ref.www.ostba.ca)

		Single	Couple*
A Membership Fees	No Refund Yearly	$20	$40
B Mandatory Deposit	Top it up Always	$85	$170
Total		$105	$210

16. I undertake to pay to the Association the call dues of $20/- on the demise fellow member in the OSTBA Death Donation Scheme, when notified within 60 days
I agree to undertake this obligation.

17. Remittance by Email / interac e transfer could be sent to: info@ostba.ca Or deposit at Our TD Bank or at BMO Bank. Phone on cell on (416) 473-6880 or on (416)-629-0065 and obtain details of our Bank’s transit and account number.

1. Receipt of Payment #

2. Payment Date

18.The contribution as per By Law#3.2 of the O.S.T.B. A Constitution goes towards the Death Donation Reserve. Your deposit of $65 shall be refunded /paid along with final payment to the beneficiary / nominee as stated in the constitution. (Certain conditions apply)

19. I will abide by the OSTBA Constitution (subject to any changes), I will remain as a Provisional Member until I complete the twelve months period from the date of first installment payment, and complete contributions and death call contributions falling, within this one-year period to become an Accredited Member eligible for benefits. You will not be provided with an accreditation certificate on completion of one year.

20. I (Your name) First Last name hereby declare below

1.First Name

2. Last Name

Hereby declare below,the names of two of my nominees, one of whom, in order of priority will be entitled to payment of the Death Donation on my demise, on production of necessary documents as per the constitution. I shall make a special declaration, if I so desire to make a shared payment between the two beneficiaries.

Nominee Information

Nominee 1

1. Full name of Nominee (1)

2. Signature

3. Relationship

4. ID

5. Phone

6. E-mail

Nominee 2

1. Full name of Nominee (2)

2. Signature

3. Relationship

4. ID

5. Phone

6. E-mail

20. Declaration: I have received or read it on website (www.ostba.ca)the copy of the O.S.T.B.A constitution in English / Tamil and I do hereby solemnly and sincerely declare the information given in this application is truth and I undertake to abide by the constitution

01. Signature of Applicant

. Date

02. Approved/ Not approved (with Reason)

. Date

03. Signature of Treasurer /Asst Treasurer-

. Date

* Signature /initial required Denotes certain conditions apply
** Refer our website www.ostb5.ca

For Official Use
Duly completed forms to be mailed to our Mail box only
————————————————————————————————————————-
Mailing address: – OSTBA, PO. Box 48068 Dundas & Sheppard, Mississauga ON L5A 4G8
511-99 Agnes road, Mississauga, ON L5B 1J9: 416-473-6880 & 416-629 0065

Email: info@ostba.ca

Nominee Information

Nominee 1

Nominee 2

Ontario Senior Tamils Benevolent Association (OSTBA)