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
Title: __ Job title: Email:

(Please print your details clearly using capital letters)

First name and initials: _____

Surname:____________________________ Department:__________________________

2. Company Information
Company name:_______________________________________________________________________ Address:_____________________________________________________________________________ _______________________________________________________________________________ State:____ Telephone: Email: Postcode(if applicable):_____________________________ Fax:________________________________ Website:____________________________

3. Service Options.
The fee is non refundable.

NJQS Subscription Fee The one-time Subscription Fee to pay is either: 25,000 (Twenty-five thousand Naira), or US$200 (Two hundred US dollars) 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 – 03460030005689 US Dollar Payment - 03460131004662 GT Bank, Plc. ACCOUNT NUMBERS: Naira Payment – 2097319114110 US Dollar Payment - 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
Version 9. 11/08 FS56567

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