BASIC VAP MEMBERSHIP

REGISTRATION FORM

Select membership*

Basic membership N55,000

Please select the product you are interested in*

Please selectAlumni & Graduation ringsCustom ringsSports team ringsSocial club ringsMotorcycle club ringsAnniversary ringsMilitary & Paramilitary ringsLodge ringsReligious ringsPilot ringsSailors' ringsAward ringsHip hop ringsOther

If you selected “other” above, please describe the type of rings you would to retail for Madewear*

please enter the type of ring you are interested in

PERSONAL INFORMATION

Age confirmation*

Confirm that you are 18 years old or older.

Gender

Please selectMaleFemaleOther

Select your date of birth*

Title*

Please selectMs.Mr.Mrs.Dr.

First name*

Middle name*

Last name*

Mobile number*

Telephone number

Email address*

Full home address*

Include any landmarks

FINANCIAL INFORMATION

How your would like to receive your commissions and bonuses?*

Bank transfer

Cheque

Paypal

Enter your bank account details*

Enter your Paypal account*

DOCUMENTATION

Upload proof of address*

Electric bill, land use document, or water bill

Upload one (1) form of Identification*

Passport bio data page, Driver’s licence, Voter’s card

CRIMINAL CONVICTIONS

Do you have any convictions, cautions, reprimands, or final warnings which you would like to disclose? *

Please selectYesNo

If you have answered yes to the question above please give details of any convictions, cautions, reprimands, or final warnings which you have.*

Are there any criminal proceedings pending against you?*

Please selectYesNo

If you have answered yes to the question above please give details of any criminal proceedings pending against you*

Have you ever been investigated for fraud, misrepresentation of information or falsification of documents? *

Please selectYesNo

If you have answered yes to the question above please give details of any fraud investigation, misrepresentation of information or falsification of documents against you. *

Has one of your previous employers, business partners or associates had to contact your guarantor for misappropriation of funds or embezzlement? *

Please selectYesNo

If you have answered yes to the question above please give details below.*

DECLARATION

I hereby confirm that the information provided herein is accurate, correct and complete and that the documents submitted along with this registration form are are true copy of the original. I also understand that any willful dishonesty may render for refusal of my application.

Are you human?*

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