Company Details
Section 1

Company Details RC: *

Company Name *
Holding Company if (Applicable).

Number of Employees: *

Year Established: *

Physical Address: *

Postal Address: (if different from above)

Telephone: *

Website:

Core Line of Business:

Other Business Interests:

Business Type:     ServiceRetailerDistributorWholesalerContractManufacturerProviderExporterImporterConsultant

Other (Please specify).

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Particulars of Directors / Partners
Section 2

Name:

Nationality:

Name:

Nationality:

Name:

Nationality:

Primary Member / Accredited Representative:

Full Name: *

Position: *

Work Phone (Direct): *

Cell Phone (Direct):

Email: *

Alternative Representative:

Full Name: *

Position: *

Work Phone (Direct): *

Cell Phone (Direct):

Email: *

Name & Address of Associated Canadian Company (ies):
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Membership Categories
Section 3

Membership Categories:  Gold MembershipPremium MembershipPlatinum Membership
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What is your Company interest in Canada?

What are your main challenges to date?

List the three areas where you believe the Association can assist your organization:

Required Documents for registration (all required document must be submitted with the application form.)

• Company Profile

• Company Annual / Financial Report

• Copy of Certificate

Company Profile:

Company Annual / Financial Report:



Copy of Certificate:

DECLARATION
We wish to be admitted as members of the Nigerian Canadian Business Association, and if admitted, we agree to be bound by the Constitution, the Memorandum and Articles of Association and any Bye-laws of the Association.
We will pay the annual fee at the rate in force for the time being, and declare that all statements made by us on this application form are correct.

Date:

Signature: *

SPONSOR
We, the undersigned, being a member of the Nigerian Canadian Business Association in good standing declare the above application for membership is known to us and in our opinion is suitable for admission to the membership of the Association.

Date:

Signature: *

Name of proposer: *

Company Represented: *

Date:

Signature: *

***Please note that the submission of this form does not guaranty registration..

Payment should be made into:
Nigerian Canadian Business Association
EcoBank Account No: 0322047171