UNITY & PROGRESS

MEMBERSHIP/ FACTORY DELEGATE FORM

MEMBER NAME: ____________________________________________

ADDRESS: ___________________________________________________

____________________________________________________________

PHONE: ______________________________________________________

E-MAIL: ______________________________________________________

FACTORY NAME: _____________________________________________

FACTORY ADDRESS: __________________________________________

______________________________________________________________

FACTORY PHONE: _____________________________________________

FACTORY E-MAIL: _____________________________________________

DECLARATION
I understand that while representing the above factory drivers at the association, I could
become liable for disciplinary action for events that engage APWAT NIGERIA Byelaw
liability to disciplinary action.

• I understand that while I am a member of APWAT NIGERIA, I will promptly

notify APWAT NIGERIA in writing about any event which may engage Byelaw/ default.
• I agree to comply with APWAT NIGERIA, Regulations, Code of Ethics and Conduct.
• I have not been subject to any criminal conviction and caution.
• I have not been disciplined by any professional body and regulator.
By signing this Delegate/ membership form, I agree to abide by the conditions of
the APWAT NIGERIA.

________________________ _____________________
MEMBER SIGNATURE FACTORY M.D SIGNATURE

THE ASSOCIATION OF PURE WATER TRANSPORTERS IN NIGERIA (APWAT)

Block 63, Plot 32, Oba Yekini Elegushi Road, Ikate, Lekki, Lagos Island, Nigeria 

Phone: +234 08030650730 Email: apwat2017@gmail.com