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የኢትዮጵያውያን እድር የመረዳጃ ማህበር በኒውዮርክ ኢንክ

Ethiopian Edir Mutual Assistance Association in New York Inc.

450 Lexington Ave. 4th Floor

C/o WeWork

New York, NY 10017

ID#______

Member Information Update Form

Member's Full Name
Maritial Status
Marriage certificate is required, if married after joining the Association
Residence Address:

If Married, please provide Spouse’s Cell Phone No. and Email address:

Names of Children under 22 years of age and Date of Birth

(Proof of age is required for children under 22 years of age)
Birthday
Birthday
Birthday
Birthday

Death Beneficiary

In order to update Beneficiary or Next of Kin information, please download the form and submit a duly completed and signed copy.

Next of Kin

(Next of kin will be contacted in the absence of a designated beneficiary or if the beneficiary cannot be reached) In order to update Beneficiary or Next of Kin information, please download the form and submit a duly completed and signed copy.

Agreement

I certify that the information provided above is true and correct.
Clear Signature
Clear Signature

Authorizing EEMAA Official’s Name and Signature:

_____________________________________________________________________ Date:_______________________________________________
Click or drag files to this area to upload. You can upload up to 10 files.
Birth Certificate - If you add a new child or a marriage certificate if you get married.

Note:

This form will be used to update member information every year (or as required), if there are any changes that need to be recorded. Please duly complete all parts, sign and either mail it to the above mentioned address or scan it and send it by email to EEMAA’s email address: eemaa2002@yahoo.com. Form Revised: Feb 2025