CIPM - Memebership Upgrade Form

Please complete every section of the form, If the space provided is insufficient, kindly write on a separate sheet of paper and attach to this form. All information contained herein will be kept in strictest confidence.

Please forward your printout to:
The Registrar, Chartered Institute of Personnel Management
CIPM House, CIPM Avenue, Alausa Ikeja, Lagos, Nigeria

PERSONAL PARTICULARS

Title

Surname

Other names

Correspondence Address

Official Tel No.

Mobile phone

Date of Birth

(dd/mm/yyyy)

Grade Applying for:

Cognate Experience in Chronological order

DATE	ORGANISATION	JOB TITLE

COMPANY'S PARTICULARS
Current Job Title
Present Employer
Address of Present Employer:
Number employed by the organisation:
Nature of Business:
Who do you report to?
Who are your Subordinates?
What are the Principal Responsibilities of your Job?
Academic/Professional Qualifications Obtained and when obtained, since Last grading( if applicable supply evidence )


Activities at National/Branch/PPCA:

SPONSOR (MUST BE AN ASSOCIATE, MEMBER OR FELLOW OF THE INSTITUTE)

Name		Membership grade & No
Organization

BRANCH/PPCA CHAIRMAN/SECRETARY
I hereby certify that the particulars given is true and correct to the best of my knowledge and belief.

Name

____________________
Signature

official stamp

____________________
Date

IMMEDIATE BOSS

Name
Designation

____________________
Signature

official stamp

____________________
Date

FOR OFFICIAL USE ONLY:

ACCOUNTS:

Applicant:
has met His/Her Financial obligations to the Institute

____________________
Signature

official stamp

____________________
Date

(A) CHAIRMAN

I,
on behalf of the membership committee hereby recommend the upgrading as:

____________________
Signature

official stamp

____________________
Date

(B) SECRETARIAT

DATE

INITIAL

Application Received

II)

Applications Submitted to Membership Committee

III)

Approval recommended to the council

IV)

Upgrade as

Notification of result issued

VI)

Membership Certificate issued