Tangerine Tangerine Pensions - 218, Olosa Stret, Victoria Island, Lagos, Nigeria Telephone: (01) 448 S490, +234 809 192 GBI, +284 706 700 7895 - www tangerinapensions.com + RCSISES RETIREMENT SAVINGS ACCOUNT (RSA) OPENING FORM “REGISTRATION TYPE ee TPIN REGULARIZATION ] NEW REGISTRATION (NAME ASIT APPEARS ON YOUR NATIONAL IDENTITY CARD) OOOO “MARITAL STATUS OO “DATE OF BIRTH (DD M MAIDEN/FORMER NAME ENTITY NUMBER (NIN) NO./NAME OF RESIDENCE WN/CITY OF RESI IMENT AREA OF RESIDENCE 1. PERSONAL DATA (fl in black ink and capital letters) “COUNTRY OF RESI P.O. BOX/PM.B my statements and ‘other correspondence by mal + EMPLOYER TYPE ves “HOUSE NO./NAMI “STREET NAME GOVERNMENT ARI ‘SSTATE OF RESIDENCE CO! 2. EMPLOYMENT RECORDS “PHONE NUMBERDATE OF FIRST APPOINTMENT too won vrrn DATE OF CURRENT EMPLOYMENT tp won ern "NATURE OF BUSINESS ** VILLAGE/TOWN/CITY “ime “GENDER “FIRST NAME MIDDLE NAME RELATIONSHIP SURNAME "STREET NAME OF RESIDENCE "LOCATION “HOUSE NO./'NAME OF RESIDENCE ** LOCAL GOVERNMENT AREA OF RESIDENCE IDENCE “* STATE OF RESIDENCE “COUNTRY OF RESIDENCE P.O. BOX/P.M, ZIP CODE PHONE NUMBEI EMAIL ADDRESS: * CONTRIBUTOR'S CERTIFICATION ‘hereby certty thatthe information provided inthis fois correct. futher consent and authorize the National dentty Management Commission torelaate my NN infomation oe may be eure fo tre National Persons Commision encom), upon reas by My + PIN * FORM REF NUMBER * SALES AGENT CODE + seu reterncenumoer [3 | 5|LC|R * FOR OFFICIAL USE ONLY DOCUMENTATION REQUIREMENTS FOR [sori puBtic AND PRIVATE SECTOR EMPLOYEES 0 » ® @ “ “ 0 ‘One recent soloed panport seed I" x4" photograph token ogc white bockground Letter of Employment tn the cate of Private Sector Employees Lear ot Fist Appointment a Atastason Later inthe cave of Pole Perzonell Transterand Acceptance of Service where applicable) Stott domiey Card or Anyone othe allowing “Navona rvs ce ‘Vimernational Passport ‘St te No in cate of Plc Sastor employe Notional Kentty Card or Enolnent Slip asd by the National dantty Menagemen Commision, ineeatng the Nationa identity Number (NN ‘Bank Vercton Number SVN Welcome Letter or ecent REA Statement showing name and PIN) |