ALL FARMERS ASSOCIATION OF NIGERIA (AFAN)

Head Office:
Suite A22, Hawthorn Suites by Wyndham, No. 1, Uke Street, Area 11, Garki, Abuja, Nigeria.
Tel: +234 803 787 3326; E-mail: afanigeria2014@gmail.com

No Farmer No Nation
No.
2 PASSPORT
MEMBERSHIP REGISTRATION FORM PHOTOGRAPHS

1. Full Name:
2. Residential Address:
3. Ward/Village/Town:
4. Local Government Area:
5. State:
6. E-mail:
7. Date of Birth: Telephone:
8. Agric. Business/Farm Address:
9. Major Commodity Association:
10. Other Commodity Association:
11. Details of Membership
(a) How Long: (b) Registration No.
(c) Rank in the Association:
12. Are you a service provider (Agric input, Dealer, Processor, Marketer,
Other (Specify):
13. Size of Farm(s) /Agric. Business:
14. Type / Livestock:
15. Bank Details:
16. Input Uses - Types, Quantities and Sources:

17. Have you ever taken Insurance on your farm or Agric. Business:
18. Next of Kin:

Applicant’s Signature / Right Thumb Print:

RECOMMENDATION BY LOCAL GOVERNMENT AFAN COORDINATOR

Signature Date

Approval by State AFAN Chairman: