Membership Registration

Registration Form

Personal Details
Staff ID:		Gender:	--- Select --- Male Female
First Name:		Last Name:
Other Name:		Department:	--- Select --- Customer Care CEO's Office Project Management Office Corporate Risk& Compliance Internal Audit Regulatory & Government Affairs Legal Services Finance Human Resources Digital & Innovation Marketing Enterprise Business Retail Sales Consumer Sales Information Technology Technical Off-payroll ESMCS Cooperative/Secretariat
Year of Birth:		Email:
Membership Category:	--- Select --- Regular Staff (FTE) Contract Staff Off Payroll Member	Membership Based	Interest Based Non-Interest Based
Designation	--- Select --- CXO Vice President Specialist Ex-Staff Manager Analyst Head Officer Director Deputy Director Site Security Officer Graduate Trainee Logistics Officer Executive Professional Driver Pool Driver 2 Executive Driver Pool Driver 1 Office Assistant Tea Boys/Girls Dispatch Rider Front Desk Executive Mail Room Supervisor Retail Officer Mobile Technician Internal Audit Officer Fleet & Insurance Admin Human Resource Officer Legal Officer Customer Service Representative 3 Customer Service Representative 2 Customer Service Representative 1 Senior Outsourcing Officer Manager, Finance & Admin Manager, Cooperative Business Officer, Finance & Admin Officer, Cooperative Business Outsourcing Officer Administrator, Cooperative Business Field Sales Officer Outsourced Retail Advisor 3 Outsourced Retail Advisor 2 Graduate Trainee - Geek Force Outsourced Retail Advisor 1 Shop Sim Registration Officer SIM Registration Officer- Supervisor External Member	Office Location:	--Select Office Location Abia Abuja (FCT) Adamawa Akwa-Ibom Anambra Bauchi Bayelsa Benue Borno Cross River Delta Ebonyi Edo Ekiti Enugu Gombe Imo Jigawa Kaduna Kano Katsina Kebbi Kogi Kwara Lagos Nassarawa Niger Ogun Ondo Osun Oyo Plateau Rivers Sokoto Taraba Yobe Zamfara

Contact Details
Address:		City:
State:	--- Select --- Abia Adamawa Abuja (FCT) Akwa-Ibom Anambra Bayelsa Bauchi Benue Borno Cross River Delta Ebonyi Edo Ekiti Enugu Gombe Imo Jigawa Kaduna Kano Katsina Kebbi Kogi Kwara Lagos Nassarawa Niger Ogun Ondo Oyo Plateau Rivers Sokoto Taraba Yobe Zamfara Osun	Telephone:
Alternate Email:		Alternate Phone:

Next of Kin Information
Full Name:		Address:
City:		State:	--- Select --- Abia Adamawa Abuja (FCT) Akwa-Ibom Anambra Bayelsa Bauchi Benue Borno Cross River Delta Ebonyi Edo Ekiti Enugu Gombe Imo Jigawa Kaduna Kano Katsina Kebbi Kogi Kwara Lagos Nassarawa Niger Ogun Ondo Oyo Plateau Rivers Sokoto Taraba Yobe Zamfara Osun
Email:		Phone:
Next of Kin's Relationship:	--- Select --- Husband Son Daughter Father Mother Uncle Aunty Brother Sister Cousin Nephew Wife

Bank Details
Bank Name:	--- Select --- 9Payment Service Bank Access Bank Ltd CITI Bank Diamond Bank Plc Eco Bank Plc Enterprise Bank FCMB Fidelity Bank First Bank of Nigeria Globus Bank GTBank Heritage Bank Jaiz Bank Keystone Bank Lotus Bank Mainstreet Bank Paga Polaris Bank Providus Bank StanbicIBTC Bank Plc Standard Chartered Bank of Nigeria Sterling Bank Transit Testing Bank Union Bank Ltd United Bank of Africa Unity Bank Wema Bank Zenith Bank Ltd	Account Number:
Bank Branch:		Sort Code:
BVN:

Contributions
Regular Savings:		Minimum Monthly Contribution:	₦5,000.00
Do you wish to Subscribe to Special Savings Scheme?:		No Yes
Special Savings Scheme:	Mode: Payroll Off Payroll
Do you wish to Subscribe to 13th Month Savings Scheme?:		No Yes
13th Month Savings Scheme:	Mode: Payroll Off Payroll		* Optional and is limited to 10% of your Monthly Salary

Referrer (Optional)
Referrer Employee ID: