Membership Application Form

All claims by applicant shall be investigated. All information would be treated with confidentiality

Submission Checklist

Application form should be with the following documents attached

  1. Recent Passport photograph
  2. Copies of Academic and Professional Certificates
  3. NYSC discharge Certificate/ Exemption letter
  4. Photocopy of Bank Payment Teller/ Receipt
  5. Referees’ reports in confidential cover
  6. Detailed Curriculum vitae to include the following information
    • Institutions attended and qualifications obtained with dates
    • Professional courses attended in the last five (5) years with dates
    • Detailed work experience with names of Organisations and dates
    • Present appointment (Job Title) with date

Application Fee

Membership Application\ Processing fee of N5, 000 (Five thousand naira only, Non-refundable), is payable to the institute of Chartered Chemists of Nigeria (ICCON) Account below. Your payment details must be completed in the application form.

United bank for Africa (UBA)
Account No.:     1017354658
Account Name:ICCON IGR






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Surname

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Other Names

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Phone Numbers (*)

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Email (*)

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Sex (*)

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Marital Status

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Local Government Area

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State of Origin (*)

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Country (*)

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Permanent Home Address (Please provide your full street Address, NOT POST OFFICE BOX NUMBER) (*)

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Correspondence Address (*)

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Office Address (*)

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Designation

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Qualification (*)

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Area of Specification

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Names and addresses of two referees who must be members of ICCON.

1st Referee

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2nd Referee

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Please provide details of where application fees were paid. Evidence of payment must be attached to this form.

Bank Name/Branch

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Teller Number (*)

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Amount Paid (*)

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Passport (200kb) (*)

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Professional Certificates (All certificates to be combined as a single .pdf document) (*)

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NYSC Certificate/ Exemption letter (*)

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Bank Teller/Receipt (*)

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Resume (*)

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I hereby declare that the information provided above are to the best of my knowledge correct.

Accept Declaration

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