REGISTRATION FORM

Personal Information

Full Name Gender Select your sex Male Female Others Date Of Birth Marital Status Select your marital status Single Married Divorced Widowed residential Address Phone Number Email Address Means of Identification Select your means of Identification Voter's Card National ID cardsd Driver's License international Passport others ID Number

Occupation Details

Occupation / Profession Employer (If Applicable) Office Business Address Estimated Monthly Income (Optional) Select estimated monthly income Below N50,000 N50,000 - N100,000 N100,000 - N200,000 Above N200,000

Membership Commitment

Why do you want to join the society Which of the society’s services are you interested in? Agriculture Support
Humanitarian Services
Loans/Savings
Real Estate Opportunities
Welfare/Community Projects
Disability & Care Support
General Trading & Investment
Others, Please Specify Preferred Monthly Contribution Preferred Mode of Payment: Select preffered mode of payment Online Cash Bank Transfer Mobile Money

Next Of Kin Information

Full Name of Next of Kin Relationship Next Of Kin Phone Next Of Kin Address

Declaration

By submitting this form you hereby apply for membership into SUPREME GUARDIAN ASA (OBAFEMI OWOSE) COOPERATIVE & MULTI-PURPOSE SOCIETY. I agree to abide by the rules and regulations of the society and contribute actively to its growth and development.
I Agree