Application for Malahat Distribution

Please fill out a separate form for each individual you are applying on behalf of. Legal custody documents or current years child tax statements MUST be provided to resolve eligibility for dependants.

All information contained on this form is held securely on Malahat Nation land and is only visible to authorized Malahat personnel.

Personal

Legal Name *

First

Middle

Last

Name Suffix

Date of Birth *

Legal Guardian (If under 18)

First

Last

Malahat Member *

Yes

Status Number *

Contact

Phone *

Email *

Address *

Address Line 1

City

State / Province / Region

Postal Code

Country

Payment

Method *

Please send an Electronic Funds Transfer (requires EFT set up with us)
Please mail it to the above address

Confirmation *

I confirm that the above information is correct
I confirm my selected payment method

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Personal

Contact

Payment