NipeX Joint Qualification System Application Form

NipeX Joint Qualification System
NipeX Joint Qualification System Application Form
To apply to join NJQS, please complete the company and payment details below and return to the NJQS team at the address shown. Upon confirmation of payment, you will be sent details of how to access the website and guidance on how to complete your questionnaire.

1. Contact Person (Please print your details clearly using capital letters)
Title: Email: __ First name and initials: _____ Surname:____________________________ Department:__________________________ Job title:

2. Company Information
Company Name:_________________________________________________________________________ Address: Telephone: Email: Postcode:_____________________________ Fax:_________________________________ Website:______________________________

3. Service Options.
The fee is non refundable.
NJQS Subscription Fee:

The initial Subscription Fee to pay is either: 25,000 Naira (Twenty-five thousand Naira) or US$200 (Two hundred US dollars) while the annual renewable fee is 20,000 Naira (Twenty thousand Naira).
Payments should be made to either of NipeX bank accounts held with UBA, PLC. and GT Bank, Plc. in the Account Name NNPC-NAPIMS-NipeX. UBA, Plc. ACCOUNT NUMBERS: Naira Payment (NUBAN):1008333080 03460030005689 US Dollar Payment(NUBAN):3000506981 03460131004662 GT Bank, Plc. ACCOUNT NUMBERS: Naira Payment (NUBAN):0006447143 2097319114110 US Dollar Payment(NUBAN):0006447150 2097319114210

Confirmation of Payment

Please attach deposit slip for the confirmation of your payment (bank branch, time and amount) so that we can reconcile the payment in our account, before issuing you the NJQS login details. 4. Return address and Contact information:
NJQS Team, 30 Lady Oyinkan Abayomi Drive (Formerly Queen’s Drive, Ikoyi, Lagos, Nigeria

Tel: +234 1 271 7592-4, +234 1 463 0400-3 Website: www.nipexng.com or www.nipex.com.ng Email: customersupport@nipex.com.ng or enquiries@njqs.org
FS56567 Version 11. 10/11

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