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Membership Form |
Please fill in all fields marked with a * |
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Name |
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Address |
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Email |
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Occupation |
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Place of work |
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Position |
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Vehicle make and number |
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Date of manufacture of vehicle |
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Drivers license number and expiry date |
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Private or commercial license |
* |
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Date and place of issue |
* |
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Can you drive at night without using full beam lights |
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Would you like to go for a free eye test |
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How many vehicles do you want to register |
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GSM phone numbers |
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Mode of payment |
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I wish to affirm that all the information given here are true and accurate. I agree to all the services being offered by ARC Nigeria and any other request outside the services being offered, the cost will be borne by me. |
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I agree to the affirmation |
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