Shell Staff Cooperative (CoopLag)

Please complete this form to the best of your ability providing all relevant details. Please note that your application will go through confirmation prior to processing. You will receice a confirmation email after submission. You must confirm your application within 72 hours otherwise your request will be discarded.

Biodata

Surname *

First name*

Other Names *

Gender *

Location *

Member Category *

Address Details

Email Address *

Phone Number *

Address *

City *

State *

Employment Details

Employer *

Member Grade *

Department *

Staff Id *

Date Employed *

Next of KIN

Full name *

Email *

Address *

Relationship *

Phone Number *

Savings and Shares

Monthly Savings

I was referred by, please enter the email address of the individual who referred the co-operative to you. Leave blank if no one referred you.

Referrer Details

Email address

I have read and agree to CoopLag membership terms and conditions.

Membership Condition

Membership of the society is opened to the following category of persons.

Membership Condition

About COOPLAG

Company

Account

Stay updated

Membership Form

Membership Condition