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Registration Form

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Upload Passport Photo(*)

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First Name(*)

Middle Name

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Surname(*)

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Date of Birth(*)

Day01020304050607080910111213141516171819202122232425262728293031

Month010203040506070809101112

Year1960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026

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Marital Status(*)

DivorcedMarriedSingle

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Sex(*)

Male Female

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Address(*)

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Mobile No.(*)

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Personal Email(*)

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Bank(*)

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Account No.(*)

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Next of Kin(*)

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Relationship(*)

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Mobile No.(*)

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Address(*)

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Email(*)

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Staff No.(*)

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Official Email(*)

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Designation(*)

Executive Vice Chairman Executive Commissioner Technical Services Executive Commissioner Stakeholder Management Director Deputy Director Assistant Director Principle Manager Senior Manager Manager Deputy Manager Senior Officer Officer Assistant Officer

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Department(*)

Corporate Services Department Board of Commissioners Commission Secretariat Compliance Monit. & Enforcement Consumer Affairs Department Corporate Planning Strategy & Risk Mgt Corporate Services Digital Economy Department Econ. Analysis and Corp. Plan. Enugu Zonal Office Exec. Comm. Stakeholder Mgmnt Exec. Comm. Technical Services Exec. Vice Chairman's Office Financial Services Department Human Capital Department Ibadan Zonal Office Information Technology Internal Audit Kano Zonal Office Lagos Zonal Office Legal & Regulatory Services Licensing & Authorization New Media & Info Security Dept Policy, Comp & Eco Analysis Dep Port Harcourt Zonal Office Procurement Department Project Management Department Public Affairs Department Research and Development Special Duties Department Spectrum Administration Dept Tec. Standards & Ntwk Integrity Universal Service Prov. Fund Zonal Operations

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Intercom Ext.

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Investment (Monthly)

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Investment (Quarterly)

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Saving (Monthly)

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Saving (Quarterly)

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I have read the Bye-law and agreed to the Terms and Conditions stated therein.

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