(This form must be filled out, turned in to your present teamwork, and sent to your area and continental offices.)

(This first section is to be filled in by departing member[s].)
Date filled in: __/__/__
Bible Name: ______________________________________________
Wife/Husband (If applicable) ________________________________
Children: (If applicable) _______________ _____________________ __________________ ________________ _____________________ __________________ ________________ _____________________

Is your Home on Probationary Notice?: Yes __ No __
What ministries or duties must you turn over before moving?
Where is your desired destination?: Home: ________ City:_________ Country: _________________________________________________

Do you have clearance?: Yes ___ No ___

Do you have your $50 Tool fund? Yes___ No___
Amount in cash: _______ Amount (value) in tools: ________

Do you have notarized permission from your parents and/or guardian to move?: Yes __ No __
(For members 16- and 17 -years of age only.)

I hereby declare that I have met all of the requirements of the Right of Mobility as found in Section 4 of the Charter.

Signature of applicant(s)

(This last section is to be filled out by the applicant's Home teamwork)

Date received this form (which begins 30-day notice): __/__/__
Home number: _________
City: ____________
Portion of debts/liabilities owed by member(s):

Are you requiring the departing member to pay his portion of debts/liabilities?: Yes__ No__
Partially __ (give details)

You as the teamwork of the Home are responsible to pass this form on to the area and continental offices within 7 days of receipt of the same.

Signatures of Home teamwork (At least two teamworkers should sign)


Copyright (c) 1998 by The Family