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Cooperative Member Registration Form
Cooperative Member Registration Form
Personal Information
Fullname
Gender
--Select Gender--
Male
Female
Date of Birth
Phone No
Email Address
Password
Residential Address
Civic Status
--Select Civic Status--
Single
Married
Divorced
Widowed
State of Origin
--Select State of Origin--
ABIA STATE
ADAMAWA STATE
AKWA-IBOM STATE
ANAMBRA STATE
BAUCHI STATE
BAYELSA STATE
BENUE STATE
BORNO STATE
CROSS RIVER STATE
DELTA STATE
EBONYI STATE
EDO STATE
EKITI STATE
ENUGU STATE
GOMBE STATE
IMO STATE
JIGAWA STATE
KADUNA STATE
KANO STATE
KATSINA STATE
KEBBI STATE
KOGI STATE
KWARA STATE
LAGOS STATE
NASARAWA STATE
NIGER STATE
OGUN STATE
ONDO STATE
OSUN STATE
OYO STATE
PLETEAU STATE
RIVERS STATE
SOKOTO STATE
TARABA STATE
YOBE STATE
ZAMFARA STATE
FCT ABUJA
NOK Fullname
NOK Phone
Bank
--Select Bank--
Access Bank
Access Bank(Diamond)
Aso Savings & Loans
Citibank
EcoBank
Ekondo Microfinance Bank
Fidelity Bank
First Bank
FCMB
GTBank
Globus Bank Limited
Heritage Bank
Jaiz Bank
Keystone Bank
Kuda Bank
OPAY
Parallex Bank
Polaris Bank
Premium Trust Bank
Providus Bank
Standbic IBTC
Standard Chartered Bank
Sterling Bank
Suntrust Bank
Titan Trust Bank
Union Bank
UBA
Unity Bank
VPAY
WEMA Bank
Zenith Bank
Account No
NIN
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