Mr. J.F.S Jegede
FCTI
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Mr. Abayomi Jayeoba
FCTI
Registrar/CE
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Associate Member Application Form

I hereby apply to be admitted as an Associate member of The Chartered Institute of Taxation of Nigeria

Applicant's Surname: Other Names:
 
Names and address of Business or employment: (P.O Box No only is not sufficient)
 
Business Telephone Number:
 
Residential Address:
 
Residential Telephone Number: Email Address:
 
Date of Birth: Nationality:
 
Professional or Academic Qualifications:
 
Honours and Decorations:
 
Is the applicant in public practice?
  If so state whether as a partner or in sole practice:
Partner:  Public Practice:
 
Give name and address of firm:
 
  if in employment, state name and address of present employer:
 
  Present Position Held:
(Where there is more than one place of business, please indicate the principal place of business. Employees of either Federal of State Revenue Departments only need to state their current Stations)
 
Student Graduate Information
(To be completed by applicants who have completed the Institute’s examinations).
 
Student’s registration number:
 
Dates of passing or exemption from the Institute’s examination
Foundation PE I
 
PE II  
 
Summary of Career:
Full details of Position held, Name and address of employer and nature of business, and Date
 
Declaration
I declare that the information given above is to the best of my knowledge and belief correct. I undertake to be bound by the Institute’s Act No 76 of 1992 and by the rule and regulations in force at the time of my admission or which may thereafter from time to time be made by the Council of the Institute.
Date Signature
  Type your name in full as signature.
 
 
Referee 1: Referee 2:
Name and address of Referee: Name and address of Referee:
Status: Status:
Associate Adm No: Associate Adm No:
 
NOTES

1) The referees must be financial members of the institute.
2) After filling the form, you must also send a printed copy accompanied by all the relevant documents stated below to the Institute.
a) This form must be accompanied with certified photocopies of academic and professional qualificaitons. (Membership Committee may call for the original copies for sighting).
b) All photocopies of your credentials must be duly certified by one of your two referees.
c) A letter of attestation from your employer stating the detailed tax working experience with the company/firm
d) Two self - addressed stamped envelopes
e) Two certified recent passport sized photographs.
3) Certified photocopy of evidence of completion of the Institute examinations (Where applicble)