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NIGER DELTA EXPLORATION &

PRODUCTION STAFF COOPERATIVE


MULTIPURPOSE SOCIETY LIMITED
REGISTRATION FORM
AFFIX
PASSPORT
PHOTO
Please complete the application below:
SECTION A – PERSONAL DATA
HERE
First Name: KINGSLEY Last Name: AJIE

Date Employed: OCT. 2015 Department: COMMERCIAL Location: LAGOS

Present Position: MANAGER COMMERCIAL


Sex: Male Y Female

Contact Address: 31 AGBOOLA AJUMOBI CRS. E-mail Address: kingsley.ajie@gmail.com


MAGODO
GRA PH 2
Mobile No: 08022920449

Next of Kin: IRENE AJIE

Relationship of Next of Kin: WIFE Next of Kin Telephone:


Monthly Savings: 100,000.00
Applicants Signature: Date: 05-NOV-2017

Names of 2 (Two) Referees – Who must be Cooperative members:-


1) ______________________________________
2) ______________________________________
SECTION B – OFFICIAL USE ONLY
Registration Number:
Registration Fee Paid:

Comments:

Authorization: Date:

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