New Membership Registration

First Name (Value Required)

Middle Name

Surname (Value Required)

Gender (Value Required)

Marital Status (Value Required)

Email Address (Value Required)

Phone Number (Value Required)

Subsidiary (Value Required)

Address Line 1 (Value Required)

Address Line 2 (Value Required)

City (Value Required)

State (Value Required)

Place of Birth

State of Origin (Value Required)

LGA of Origin (Value Required)

Member Staff Number

Department

Alternate Phone Number

Account Type

Account Number (Value Required)

Alternate Email Address

Minimum Monthly Contribution (Value Required)

Declaration Acceptance (Value Required)

Declaration

I understand that as part of AIRTEL STAFF Cooperative Multipurpose Society (refer to as the Cooperative) business process, the Cooperative will collect, process, store and use my personal data (and other sensitive or confidential data) to process my transactions within the Cooperative. I am aware that the personal data required by the Cooperative for the purposes mentioned herein may include: my name, gender, date of birth, house address, next of kin and their contact details, monthly savings and loan details, bank account number and other related data.

I confirm that I have read and understood the purpose of collecting my data. In consideration of all the information stated above that are within my knowledge, I hereby consent to the collection, processing, use and transfer of my personal data for the purposes stated herein.