Membership Application - Barnawa Rahma Cooperative

Join Our Cooperative

Become a member of Rahma Multipurpose Cooperative Society

Personal Info

Salary Details

Complete

Section A

MEMBERSHIP APPLICATION FORM — STAFF FORM

Personal Information

ID No.

Membership No.

Registration Date

Surname *

Other Names *

Home Address *

Office Address

Phone Number *

Email Address *

Date of Birth *

Gender *

State of Origin *

Local Government Area *

Marital Status *

Next of Kin Name *

Relationship to Next of Kin *

Next of Kin Phone *

Next of Kin Address *

Referee Name

Referee ID No

Referee Membership No

🔐 Account Security

Password *

Secret Name (for password recovery) *

You will use this secret name to recover your password if you forget it.

Confirm Password *

Step 1 of 2

Section B

Authority to Deduct from Salary

Salary Deduction Details

Please deduct from my salary the sum of ₦ for the credit of account with Barnawa Rahma Multipurpose Cooperative Society, Nigerian Geological Survey Agency (National Geosciences Research Laboratories Centre) with effect from and until further notice.

IPPIS NO *

Department *

Monthly Salary *

Date of First Appointment *

Expected Date of Retirement

Step 1 of 2

Join Our Cooperative

MEMBERSHIP APPLICATION FORM — STAFF FORM

Authority to Deduct from Salary

Application Submitted Successfully! 🎉