Corporate registration form CORPORATE APPLICATION FORM Before Submission, a payment of 25,000 for the Corporate Application form should be made HERE or via the TSA Account on REMITA platform. You are to log on to www.remita.net, and click on “pay federal government agency.” From the list of agencies, choose “Institute of Chartered Chemists of Nigeria”, indicate the amount, purpose of payment etc. Corporate form should be returned with the following: A copy of the organization’s Certificate of Incorporation Profile of the organization One recent passport photographs of the CEO / Contact person A copy of appointment letter of each of the organization’s technical personnel who must bechemists A copy of evidence of payment (remita receipt) All documents should be sent to: (icconapplicationformsubmission@gmail.com) (Please note that, after the purchase of the Application Form, the Registration Fee is to be paid after the application has been processed and approved, the approval of which will be communicated to the organization concerned.) 1 Name of Organization * Address * Telephone Number Email * Website 2 Year of Incorporation/RC Number Name of Chief Executive / Contact Officer * Phone / GSM Nos. of CEO * Email Staff strength Number of branches Number of Chemists in the employment of the organization 3. Names and Qualifications of Chemists working in the Organization A B C D 4. Give a summary of the activities of your Organization (in addition, it is advisable to attach a corporate profile, where available) Max. 300 words 5. Is your organization affiliated to any other body (ies) – either locally or internationally? If yes, please state the name (s) and address (es) of the said body (ies) 6. Names and addresses of two Referees who should be ICCON members (At least one of them must be a Fellow of the Institute). and they must be financially up to date with their dues. Download this form and send to your referees to provide their required information, forms should be sent to: (icconapplicationformsubmission@gmail.com) Download Here i Name Address Membership / Professional Status ii Name Address Membership / Professional Status 7. Payment Details Name of Bank / Branch * Receipt / RRR Number Amount Paid * 8. Details of Organization's chemists who serve as technical officers. i Name Name First First Last Last Email Phone Number(s) Date of Present Appointment Date/Signature ii Name Name First First Last Last Email Phone Number(s) Date of Present Appointment Date/Signature iii Name Name First First Last Last Email Phone Number(s) Date of Present Appointment Date Declaration * I Declare I hereby declare that the above information provided is the best of my knwledge and correct. If you are human, leave this field blank. Submit