THE NIGERIAN INSTITUTE OF PROFESSIONAL SECRETARIES

(Association of Qualified Secretaries - Established under Decree No.1 of 1990)

18A Modele Street off Tejuosho Road Surulere Lagos. P.O.Box 1184, Ikeja, Lagos

01-7212484, 01-8197299, 08045433061, 08033011365, 08058441143

nips12000@yahoo.com, www.nipsecretaries.org

To: The Director-General, NIPS, Lagos.

APPLICATION NUMBER: .............................................

APPLICATION FORM FOR MEMBERSHIP

This Form should be completed and returned with certified copies of certificates, diplomas and other documents in support of qualifications claimed by the applicant to the Nierian Institute of Professional Secretaries

PLEASE PRINT ALL ENTRIES LEGIBLY

SECTION ONE

I agree that in the event of my admission to membership, I will be governed by the Rules of the Institute, whether contained in Articles of Association, By-Laws or otherwise, as they now exist or as may in future be altered; I will further the objectives of the Institute as far as I am able and will attend its meetings as often as I can, making special efforts for Annual General Conference, etc.

I, the undersigned certify that the statement made by me in this application are correct:

Mr/Mrs/Miss..................................................................................................................................

Date..............................Signature...................................Telephone No.........................................

02 Surname.......................................................................................................................................

03 Other Names...............................................................................................................................

04 Date of Birth........................Sex................. Marital Status...............................................

05 Age...................Nationality..........................State of Origin...............................................

06 Religious Affiliation........................................................

07 RESIDENTIAL ADDRESS:................................................................................................................

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	08 Mailing Name...........................................................................................................................

	09 Mailing ADDRESS ................................................................................................................ ...................................................................................................................................................... .......................................................................... Post Code ............................... Email Address:........................................................ SECTION TWO Current Employment Job Title:.................................................................................................................................... Employer's Name:.............................................................................................................................. ............................................................................................................................................................................... .Nature of Employer ............................................................................................................ ............................................................................................................................................................................... Employer's Address:.................................................................................................................................... ..........................................................................Telephone................................................................. Previous Employment Job Title:........................................................................................................................................ Employer's Name:.......................................................................................................................... Nature of Employer's Business:................................................................................................... Employer's Adress:................................................................................................................... ..................................................................................................Telephone.................................. SECTION THREE EDUCATION (Full details of qualification must be entered in the appropriate section and relevant certificates must be submitted for inspection on demand)
	UNIVERSITY OR POLYTECHNIC FULL/PART TIME DATE DEGREE OBTAINED





		S.S.C.E/G.C.E.& Equivalent Main Subjects O or A Date



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	PROFESSIONAL QUALIFICATION............................................................................................ MEMBERSHIP GRADE APPLYING FOR...................................................................................

	SECTION FOUR

	STATEMENT OF VERIFICATION Verification can be by the signature below of a Fellow, Member or Associate members of the Institute, Supervisor or Senior Colleagues of the application who has first hand knowledge of the applicant's work.
	This information supplied by the Applicant is verified by me where I have initiated the entries: Company................................................................................................................................................................ Name (BLOCK LETTERS).................................................................................................................................... SIGNATURE................................................................................DATE................................................................. PAYMENT OF MEMBERSHIP FORM/BROCHURE AND REGISTRATION FEES Application for Membership Form should be completed and returned to the Director-General ,enclosing

	(1) Two (2) passport photographs certified by your signatory (2) Photocopies of Educational Qualifications (3) The original of the completed Membership Application Form AND (a) FELLOWSHIP GRADE -To be decided by the Excutive Council at the time of Up-grading to Fellowship of the Institute. (b) FULL MEMBERSHIP - N10,000.00 - To cover Form/Brochure and Registration Fees (c) Graduate Membership - N7,000.00 - To cover Form/Brochure and Registration Fees. (d) ASSOCIATE GRADE - N5,000.00 - To cover Form/Brochure and Registration Fees.
	(e) INDUCTION FEE - To be stated in your Letter of Membership Admission.
	NOTICE - Please note that completed Application Form reciveded without the appropriate Fee will not be processed. METHOD OF PAYMENTS TO THE INSTITUTE: 1. AT THE SECRETARIAT- (a) by cash in person at the Secretariat (b) by certified bank draft made payavble to NIP SECRETARIES and delivered by hand or post (Courier Service) to the Director-General at the Secretariat, Lagos. 2. THROUGH THE BANK: (a) Account Name - NIP SECRETARIES (b) Skye Bank Plc, Isolo Branch, Lagos. Account No. 2371770004050 (c) United Bank for African Plc, Ojuelegba Road Branch, Lagos. Account No. 00890030002125 (A copy of the Pay-in slip should be sent to the Direrctor-General and Official Receipt will be issued to you)

			SECTION FIVE FOR OFFICIAL USE ONLY

		Date Application Received Amount Enclosed Receipt No. Issued

		Membership Committee Recommendation:

CHAIRMAN SECRETARY DATE: DATE: