FERTILIZER PRODUCT

							                                   F E P S A N

           FERTILIZER SUPPLIERS ASSOCIATION OF NIGERIA
                                   Membership Application Form
                    (Information provided will be treated in strict confidence)

                                                             Date:
1.     Business Name: ______________________________________________________
2.     Type of business: (tick):

       (1) Manufacturing             (2) Importing          (3) Blending
       (4) Distributing/Whole selling            (5) Other (specify) ______________________

3.     Contact Persons:     1) Name: ______________________ GSM _________________
                            2) Name: _______________________ GSM_________________
4.     Postal Address:

                               OFFICE                 FACTORY                WAREHOUSE


          Address


          Telephone
          Fax
          GSM
          E-Mail
          Website

5. Type of membership applied for (see back for details)

      Signature of Applicant: ____________________________________________________
      Name in full: __________________________________________ Date: _____________

                                      FOR OFFICE USE ONLY


6.     Application received by: ______________________________ Date: _____________
7.     Reviewed and recommended by: _______________________ Date: ______________
8.     Approved by: ______________________________________ Date: ______________
9.     Membership certification No: _________________________ Date: _______________
                  CATEGORIZATION OF MEMBERSHIP AND DUES

1.   The following categories of members have been adopted for registration with the
     Association.

               Regular Members      - include manufacturers, importers and bending plants whether
                                      as corporate entities or sole proprietors.

               Associate Members    - include wholesale distributors/dealers, bulk handlers, clearing
                                      agents and transporters, and manufacturers, importers,
                                      producers and providers of other agric inputs such as seeds,
                                      agro chemicals, credit, equipment, etc. whether as corporate
                                      bodies, sole proprietors or individuals.

               Affiliate Members      - include retailers and other associations and individuals
                                     involved in agric input supply and marketing at retail level,
                                     farmers’ organizations, agric-commodity trade associations,
                                     NGOs and CBOs. It also includes public and private
                                     organizations and individuals involved in the regulation,
                                     control, registration, research, development, testing and use
                                     of fertilizer.

               Honorary Members     - include any corporate entity or individual who in the opinion
                                     of the Executive Committee will be of assistance in
                                     promoting the cause and interest of the Association.


2.   The fees for each category of members are:

      Members Categories                          Registration fees            Annual Subscription
      Regular members                                 N200,000.00                     N100,000.00
      Associate members                               N100,000.00                      N50,000.00
      Affiliate members                                N50,000.00                      N25,000.00
      Honorary members                                     -                             -




     You can make payment direct to Fertilizer Suppliers Association of Nigeria, account number
     035102000245 at Platinum Habib Bank (Bank PHB), Central Business District, Abuja.




                                                   2