ICCS Membership Application

Section A Personal Information

Last Name *

First Name *

Other Names

Residential Address *

Phone (Primary) *

Phone (Secondary)

E-mail Address *

Date of Birth *

Section B Professional Details

Profession / Occupation

Citizenship / Nationality

National ID / Passport / Driver's Licence No.

Employer Information

Employer Name

Employer Address

Next of Kin

Full Name *

Relationship *

Address

Phone

Type of Membership *

🏠Individual

📈Corporate

💼NGO

Additional Information / Supporting Your Application

Section D Document Uploads

Upload the required documents below. Accepted formats: JPG, PNG, WebP or PDF · Max 5 MB per file.

🪪 Passport Photo Recent colour photograph
on white/light background Required

🪪 National ID / Passport NIN slip, Voter's card,
Int'l Passport or Driver's Licence Required

🧾 Payment Receipt Bank teller / transfer
confirmation for shares Required

Section C Shares & Payment

Membership fee is non-refundable after 3 months. A fee of ₦5,000.00 per share is payable to the ICCS Limited Bank Account. Minimum purchase is 20 shares.

Jaiz Bank Plc.

0001084597

Islamic Crescent Co-operative Society, Limited

Taj Bank Plc.

0008133628

Islamic Crescent Co-operative Society, Limited

Please submit this form along with the bank teller, a passport photo, and other relevant documents for further processing.

Islamic Crescent Co-operative Society (ICCS), Limited