Business Information

Required fields are noted with an asterisk.

Please note that value fields do not accept commas or decimal points.

Company Information

Name of Company:

DBA Company Name:

Company Ownership: Publicly TradedPrivately OwnedGovernment Institution/Agency

Owner 1

Name	Title/Designation	E-Mail

Gender	Owner Ethnicity	% Ownership
	Please specify
LGA	State of Origin

Owner 2

Name	Title/Designation	E-Mail

Gender	Owner Ethnicity	% Ownership
	Please specify
LGA	State of Origin

Owner 3

Name	Title/Designation	E-Mail

Gender	Owner Ethnicity	% Ownership
	Please specify
LGA	State of Origin

Total Number of Employees:

Registered Address

Address:

City/Town:
Country:
State/Region:
Zip/Postal Code:
Registered E-Mail Address:
Confirm E-Mail:

Check if Correspondence address is same as Registered Address.

Correspondence Address

Address:

City/Town:
Country:
State/Region:
Zip/Postal Code:
Remit To E-Mail:
Confirm E-Mail:

Company Phone Number:

Company Fax Number:

Company Web Site (URL):

Contact Information

Management Contact

First Name of MD/CEO:

Last Name of MD/CEO:

Title/Designation:

Phone Number:

Ext.

Mobile Number:

Fax Number:

E-Mail Address:

User Name:

Contact Information

Check if same as Management Contact

Primary Contact

First Name:

Last Name:

Title/Designation:

Phone Number:

Ext.

Mobile Number:

Fax Number:

E-Mail Address:

User Name:

Secondary Contact

First Name:

Last Name:

Title/Designation:

Phone Number:

Ext.

Mobile Number:

Fax Number:

E-Mail Address:

Please provide details of Board of Directors/ or Authorized Officers

Director 1 /or Authorized Officer 1

Director's Name:
Title/Designation:
Phone Number:
E-Mail Address:

Director 2 /or Authorized Officer 2

Director's Name:
Title/Designation:
Phone Number:
E-Mail Address:

Director 3 /or Authorized Officer 3

Director's Name:
Title/Designation:
Phone Number:
E-Mail Address:

Director 4 /or Authorized Officer 4

Director's Name:
Title/Designation:
Phone Number:
E-Mail Address:

Upload Form C02 - Statement of Share Capital & Return of Allotment Shares:

Upload Form C07 - Particulars of Directors & Any Change Therein:

*Upload Organization Chart:

Nigerian State where the Company Head Office is located:

Other Branches: