FORM No: NSC/SRS/97/0030/II

NIGERIAN SHIPPERS’ COUNCIL (Established by CAP 327 of Laws of the Federation of ) MEMBERSHIP APPLICATION FORM

Please return after completion to: TYPE OF MEMBERSHIP REQUIRED (Tick One)

The Registrar, CORPORATE (Limited Liability Companies, PLCs etc.) Shippers' Registration Scheme, Nigerian Shippers’ Council, TRADE GROUP / ASSOCIATION (commodity groups, 4, Park Lane, Apapa, chambers of commerce, recognised business groups) P. M. B. 50617, Ikoyi, . BUSINESS NAMES (own name, partnerships, business Tel: 01 – 5458813-14 names) E-mail: [email protected] Website: www.shipperscouncil.com PUBLIC AGENCY (Federal/State/Local Government organisations, parastatals and companies etc. ) OR: Any Nigerian Shippers’ Council office nearest to you. ASSOCIATE (potential shippers, clearing & forwarding (Please see reverse side for addresses) companies, insurance companies, banks, law firms etc.)

APPLICANT SHIPPER’S DATA

NAME______(Name of Company / Group /Business Names / Agency / Associate to be registered)

ADDRESS______(Street Name)

CITY______STATE______P. O. BOX______P. M. B______

TELEPHONE______FAX______E-MAIL______

CONTACT PERSON______DESIGNATION______

SECTOR OF ACTIVITY (Please state only the most important areas of activity)

I= IMPORT, E = EXPORT COMMODITY LINE FREQUENCY OF ANNUAL VOLUME/ (Tick Box) (Insert in box below) CLASSIFICATION SHIPMENT TONNAGE (Metric Tonnes/TEUs) I E MT TEU

MEMBERSHIP OF ASSOCIATIONS

MEMBER OF TRADE OR COMMODITY ASSOCIATIONS: YES NO

NAME OF THE ASSOCIATION______

APPLICANT SHIPPER’S SIGNATURE AND STAMP: ______DATE______CONTACT ADDRESSES

ZONAL COORDINATING OFFICES

NORTH-WEST NORTH-CENTRAL NORTH-EAST 54/55 AIRPORT ROAD, SHIPPERS PLAZA, 7, JOSEPH GOMWALK ROAD, KANO, 438, MICHAEL OKPARA WAY, , . TEL: 064-647874, 637719 WUSE ZONE 5, TEL: 073-458166 P.M.B. 296, GARKI, ABUJA TEL: 09-5238291, 5238297

SOUTH-WEST: SOUTH-EAST LAGOS 75, WAY, 103, AZIKIWE ROAD, ABA, 4, PARK LANE, APAPA, BENIN CITY, EDO STATE ABIA STATE LAGOS TEL: 053-254356 TEL: 082-227656 TEL: 01-5452983, 5451351

HEAD OFFICE 4, PARK LANE, APAPA, P.M.B. 50617, IKOYI, LAGOS. TEL 01-5451352-3, 5452984-6 E-mail: [email protected]

FOR NIGERIAN SHIPPERS’ COUNCIL USE ONLY

MEMBERSHIP COMMITTEE’S COMMENTS: RECOMMENDED NOT RECOMMENDED

COMMITTEE CHAIRMAN’S SIGNATURE DATE

REGISTRAR'S APPROVAL: APPROVED NOT APPROVED

REGISTRAR'S SIGNATURE DATE

MEMBERSHIP No.: N S C

Published and Printed by MIS Division, Nigerian Shippers¶ Council, 4, Park Lane, Apapa, Lagos