Register – BRIPAN

Bripan Annual General Meeting Membership & Engagement Forum Bripan Annual General Meeting Membership & Engagement Forum

+234 912 111 4111

info@bripan.org.ng

21, Araromi Street Off Moloney Onikan, Nigeria.

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Join BRIPAN and be part of a community of professionals dedicated to advancing the business recovery and insolvency profession in Nigeria

Membership Application Form

Please fill in the Form below with accurate information.

How would you like to join BRIPAN?(Required)

Select the membership category that best describes your professional pathway.

Fellow

Associate

Full Name(Required)

Surname Other Names

Email(Required)

Telephone No(Required)

Date of Birth(Required)

Username(Required)

Enter Username

Password(Required)

Enter Password Confirm Password

Residential Address(Required)

Mobile(Required)

Gender

Marital Status

Nature of Business or Employment

Place of Business or Employment (Principal Place and whether in Practice).

Membership of other Professional Bodies/Reg. Numbers

Qualification (Attach photocopies of certificate)

A.) Qualification(Required)

A.) Date Obtained(Required)

A.) Supporting Document (Qualification)(Required)

Max. file size: 10 MB.

B.) Qualification

B.) Date Obtained

B.) Supporting Document (Qualification)

Max. file size: 10 MB.

C.) Qualification

C.) Date Obtained

C.) Supporting Document (Qualification)

Max. file size: 10 MB.

BRIPAN Students only

Are you applying as a BRIPAN Student?(Required)

Yes

A.) Student Qualification(Required)

A.) Date Obtained(Required)

A.) Supporting Document (Qualification)(Required)

Max. file size: 10 MB.

B.) Student Qualification(Required)

B.) Date Obtained(Required)

B.) Supporting Document (Qualification)(Required)

Max. file size: 10 MB.

Membership of Other Professional Bodies (Attach Photocopies)

A.) Professional Body(Required)

A.) Registration Number(Required)

A.) Supporting Document (Prof. Body)(Required)

Max. file size: 10 MB.

B.) Professional Body

B.) Registration Number

B.) Supporting Document (Prof. Body)

Max. file size: 10 MB.

C.) Professional Body

C.) Registration Number

C.) Supporting Document (Prof. Body)

Max. file size: 10 MB.

Referee/Sponsor Recommendation (By at least 2 members)

First Referee

A.) Name & Membership No

A.) Address

A.) Signature

Max. file size: 10 MB.

Second Referee

B.) Name & Membership No

B.) Address

B.) Signature

Max. file size: 10 MB.

Details of Previous Insolvency Work Experience

Please upload your recent passport photograph (JPEG,PNG)

Accepted file types: jpg, png, Max. file size: 10 MB.

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State(Required)

Signature

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Qualification (Attach photocopies of certificate)

BRIPAN Students only

Membership of Other Professional Bodies (Attach Photocopies)

Referee/Sponsor Recommendation (By at least 2 members)

First Referee

Second Referee

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