NipeX Joint Qualification System Application Form

NipeX Joint
Qualification System

NipeX Joint Qualification System Application Form

To apply to join NJQS please complete the company and payment details below and
return to the NJQS team at the address shown. Upon confirmation of payment, you will
be sent details of how to access the website and guidance on how to complete your
questionnaire.

1. Contact Person (Please print your details clearly using capital letters)

Title: __ First name and initials: _____ Surname:____________________________

Job title: Department:__________________________
Email:

2. Company Information
Company name:_______________________________________________________________________
Address:_____________________________________________________________________________
_______________________________________________________________________________
State:____ Postcode(if applicable):_____________________________
Telephone: Fax:________________________________
Email: Website:____________________________

3. Service Options.
The fee is non refundable.

NJQS Subscription Fee

The one-time Subscription Fee to pay is either:

25,000 (Twenty-five thousand Naira), or US$200 (Two hundred US dollars)

Payments should be made to either of NipeX bank accounts held with UBA, Plc. and
GT Bank, Plc., in the Account Name NNPC-NAPIMS-NipeX.

UBA, Plc. ACCOUNT NUMBERS: GT Bank, Plc. ACCOUNT NUMBERS:

Naira Payment – 03460030005689 Naira Payment – 2097319114110
US Dollar Payment - 03460131004662 US Dollar Payment - 2097319114210

Confirmation of Payment
Please attach deposit slip for the confirmation of your payment (bank branch, time
and amount) so that we can reconcile the payment in our account, before issuing you
the NJQS login details.

4. Return address and Contact information:

NJQS Team, 30 Lady Oyinkan Abayomi Drive

(Formerly Queen’s Drive, Ikoyi, Lagos, Nigeria
Tel: +234 1 271 7592-4, +234 1 463 0400 - 3
Website: www.nipexng.com or www.nipex.com.ng FS56567

Email: customersupport@nipex.com.ng or enquiries@njqs.org

Version 9. 11/08