COOPERATIVE MEMBERSHIP REGISTRATION FORM

Nigeria Research And Allied Institutions Multipurpose Cooperative Society LTD (NRAI)

Full Name (Surname First) *

Email Address *

Date of Birth *

Gender *

Male Female

Phone No *

WhatsApp No *

Home Town *

L.G.A of Origin *

State of Origin *

Residential Address *

Name of Organisation *

Office Address *

Occupation *

IPPIS Number (If Applicable)

Designation / Rank (Only If Applicable)

Monthly Salary or Avg Monthly Income *

Institutions Attended With Dates *

Full Name of Next of Kin *

Relationship With Next of Kin *

Passport Photograph * Upload 1 supported file: image. Max 5 MB.

Signature * Upload 1 supported file: image. Max 5 MB.

Declaration
I hereby declare that all the information provided above is true and accurate to the best of my knowledge.