Up-Co-operative Software
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Personal Details
Staff ID:
Gender:
Female
Male
x
First Name:
x
Last Name:
x
Other Name:
Membership Category:
Contract Staff
Full Staff
Non-Staff
x
D
ate of Birth:
x
Email:
Department:
Accounts & Finance
Admin
Call Centre
Claims Administration
Client Services
Case Management
Provider Management
ITN
Underwriting & Enrolment
Human Resources
Internal Audit
Risk & Compliance
Claims Quality Assurance
Sales & Distribution
Wellness
Brand & Communication
Contact Details
Residential Address:
x
City:
State of Residence:
Abia
Adamawa
Abuja
Akwa-Ibom
Anambra
Bayelsa
Bauchi
Benue
Borno
Cross-River
Delta
Ebonyi
Edo
Ekiti
Enugu
Gombe
Imo
Jigawa
Kaduna
Kano
Katsina
Kebbi
Kogi
Kwara
Lagos
Nasarawa
Niger
Ogun
Ondo
Osun
Oyo
Plateau
Rivers
Sokoto
Taraba
Yobe
Zamfara
x
Telephone:
x
Next of Kin Information
Full Name:
x
Address:
City:
State:
Abia
Adamawa
Abuja
Akwa-Ibom
Anambra
Bayelsa
Bauchi
Benue
Borno
Cross-River
Delta
Ebonyi
Edo
Ekiti
Enugu
Gombe
Imo
Jigawa
Kaduna
Kano
Katsina
Kebbi
Kogi
Kwara
Lagos
Nasarawa
Niger
Ogun
Ondo
Osun
Oyo
Plateau
Rivers
Sokoto
Taraba
Yobe
Zamfara
Email:
Phone:
x
Next of Kin's Relationship:
Brother
Sister
Wive
Husband
Father
Mother
Uncle
Aunty
Nephew
Niece
Friend
Cousin
Son
Daughter
Bank Details
Bank Name:
Access Bank Plc
Citibank Nigeria Limited
Coronation Merchant Bank
Ecobank Nigeria Plc
FBNQuest Merchant Bank
Fidelity Bank Plc
First Bank of Nigeria Limited
First City Monument Bank Plc
FSDH Merchant Bank
Guaranty Trust Bank Plc
Heritage Banking Company Limited
Jaiz Bank Plc
Keystone Bank Limited
Polaris Bank Limited
Providus Bank Limited
Nova Merchant Bank
Rand Merchant Bank
Stanbic IBTC Bank Plc
Standard Chartered
Sterling Bank Plc
SunTrust Bank Nigeria Limited
Taj Bank Limited
Union Bank of Nigeria Plc
United Bank for Africa Plc
Unity Bank Plc
Wema Bank Plc
Zenith Bank Plc
x
Account Number:
x
BVN:
Contributions
(Please, note that the
minimum contribution is ₦5,000.00)
Monthly Contribution:
Start Date
By clicking on submit,you agree to
pay an entrance fee of ₦3,000.00)