WAPCooP

MEMBER REGISTRATION

Indicate registration application option New member registration Edit existing registration data

Indicate login credential Staff ID: Password:
Your login credential is contained in previous email sent to you from the cooperative

Are you a Direct Hire of West African Gas Pipeline Company Limited? Yes No

Specify your WAPGCO Staff Number:

Do you reside in Nigeria? Yes No

I, Identification/Staff Number: , named below, hereby apply for membership of the WAPCo Badagry Cooperative Multipurpose Society Limited. I have accepted a non-refundable sum of to WAPCooP for membership application.


NOTE: All fields with red asteric (*) are compulsory You are required to have paid the membership registration fee of five thousand naira (N5000) to the cooperative before continuing with your application. Kindly contact the Secretariat Representatives at your work location for account payment details. Payment can be made via cheque or direct transfer. No cash payments are allowed. If paying by cheque, cheques should be made payable to The West African Gas Pipeline Cooperative Multipurpose Society, Badagry, Lagos State. Nigeria. Cheques will require clearing before processing the application. Your payment will be confirmed by the Financial Secretary before your application can be processed.
PAYMENT METHOD
Select Method: *			Trans. Date: *
Description/Comment:

I agree to be bound by the provisions of the Bye-Laws of the Society and other rules and regulations that may be issued by the Management Committee from time to time

Dated this day of ,

Surname:

First Name:

Other Names:

Gender:

Date Of Birth:

Marital Status:

Nationality:	*	State Of Origin:	*
		LGA Of Origin:	*

Company Name:		Job Title:	*
Employment Date:	*	Department:	*

Residential Address:	*
State of Residence:	*	LGA of Residence:	*

Office Location:

Work Phone/Extension:		Work Email:
Private Telphone/Mobile:	*	Private Email:	*

Postal Address:
Postal - State:		Postal - LGA:
Postal Code:

Declarations

1.	IF ADMITTED, DO YOU AGREE THAT YOU WILL NIETHER GIVE NOR RECEIVE BRIBE ON BEHALF OF THE SOCIETY?	Yes No
2.	IF ADMITTED, DO YOU AGREE TO ABIDE BY ALL THE BYLAWS AND POLICIES OF THE SOCIETY?	Yes No
3.	IF ADMITTED, DO YOU UNDERSTAND AND AGREE THAT PER THE BYLAWS AND POLICIES OF THE SOCIETY, YOU ARE OBLIGATED TO MAKE MANDATORY MONTHLY SAVINGS CONTRIBUTIONS?	Yes No
4.	DO YOU UNDERSTAND AND CONSENT THAT THE SOCIETY MAY CONDUCT BACKGROUND CHECKS ON YOU FOR THE PURPOSE OF EVALUATION OF YOUR MEMBERSHIP APPLICATION?	Yes No

Monthly Contribution to Thrift/Regular Savings

Contribution Amount	*
Mode of Contribution:	* Issuance of cheque and on-line transfer is taken as 'CASH'

NOTE: You can always change your monthly contribution after you have been registered as a member.

Next Of kin


Next of Kin Surname:	*	Other Names:	*
Next of Kin Phones:	*	Relationship	*
Next Of Kin Address.:	*

Bank Account Information. Two bank accounts specifications are provided for


Account Number:	*	Account Name:	*
Bank:	*

Account Number:		Account Name:
Bank:

Attestation

1.	HAVE YOU RECEIVED CONFIRMATION OF YOUR EMPLOYMENT FROM EMPLOYER?	Yes No
2.	DO YOU BELONG TO ANY OTHER COOPERATIVE SOCIETY?	Yes No
3.	HAVE YOU EVER BEEN CONVICTED IN A COURT OF LAW UNDER THE LAWS OF NIGERIA BEFORE?	Yes No
4.	DO YOU HAVE ANY CASE WHERE YOU ARE A DEFENDANT CURRENTLY BEING PROSECUTED IN A COURT OF LAW UNDER THE LAWS OF NIGERIA BEFORE?	Yes No
	Give Details of Conviction/Prosecution

I, , certify that all information given above is TRUE and CORRECT to the best of my knowledge. I understand that my application or membership may be revoked now or in the future if determined that I have made any fraudulent/false declaration in this application.


GUARANTOR(S) SPECIFICATION
Member ID	Member Name
You can change your guarantors after you have submitted the form. Click on the 'Edit Application' button on the left pane to perform this.

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