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Student
Membership Application
A) MEMBER
Name
Postal Address
City / Town
Region
Country
Tel no.
Mobile no.
Email
B) EMPLOYER
Name of Employer
Email
Designation
Department
Postal Address
Business Address
Town / City
Region
Country
Direct Tel no.
Direct Fax no.
Mobile no.
C) PAYMENT METHOD
For EFT or direct payment, please email copy of transaction slip to info@nicg.org.na
BANKING DETAILS
Name of Bank
: First National Bank Namibia
Account Number
: 62275853507
Branch Code
: 281872
Branch
: FNB Commercial Branch
D) I DECLARE THAT:
All information contained in this application form is true and correct.
This is an application for membership. No reference of affiliation with NICG (Namibia) will be made until approved and accepted.
If accepted, I agree to abide by the Memorandum and Articles of Association and Rules / Codes of the Namibia Institute of Corporate Governance (NICG).
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