New Member Registration

Member Photo *

Signature *

Personal Information

Full Name (Surname first) *

Gender *

Marital Status *

State of Origin *

Local Government Area *

Date of Birth *

Place of Birth

Residential Address *

Email Address *

Phone Number *

Office Name

Office Address

Employment & Membership Details

Agency Name *

IPPIS Number

File Number

Rank

Grade Level

Grade Step

Date of 1st Appointment *

Likely Date of Retirement

Coop File Number *

Proposed Monthly Savings (₦) *

Salary Bank Name *

Salary Account No *

IMPORTANT NOTICE: Your Next of Kin information MUST match your submitted paper form.

Next of Kin Information

Review Your Details

Please confirm that all information is correct before submission.

I acknowledge that ₦5,000.00 will be deducted as entrance fee.