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Request Group Plan
Name of Organization
*
0
Company Address
*
full permnent address
1
State
*
select your State
Abia
Adamawa
Akwa Ibom
Anambra
Bauchi
Bayelsa
Benue
Borno
Cross River
Delta
Ebonyi
Edo
Ekiti
Enugu
Gombe
Imo
Jigawa
Kaduna
Kano
Katsina
Kebbi
Kogi
Kwara
Lagos
Nassarawa
Niger
Ogun
Ondo
Osun
Oyo
Plateau
Rivers
Sokoto
Taraba
Yobe
Zamfara
FCT Abuja
2
Group packages
*
please select preffered package.You would be required to make payments yearly not monthly.
Employee Group Plan (1,300 Naira/Month)
Cooperative/association group plan(1,050 Naira/Month)
3
GROUP DETAILS
4
No. of Group Members
*
5
CONTACT PERSON
6
First Name
*
7
Last Name
*
8
Email
*
insert a valid email address
9
Confirm Email
*
Confirm email address
10
Contact Number
*
Your contact Phone Number here
11
Alternative Phone Number
*
Kindly state alternative contact Number
12
Upload Scanned copy of Certificate of Incorporation
*
please click upload
Upload
13
Please Note that if you decide to proceed to payment after submitting the form, Plan payments are done on a yearly basis.
14
Submit
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