Participant Registration/Membership FormPlease enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.SECTION 1: PERSONAL INFORMATIONName *FirstMiddleLast Phone Birth Activity Date of Birth *Gender *MaleFemaleAddress *Phone *Email *National ID/Cooperative ID *(If Applicable)SECTION 2: BUSINESS INFORMATIONBusiness NameType of BusinessBusiness AddressPrimary Business ActivityAnnual RevenueBelow ₦1,000,000₦1,000,000 - ₦5,000,000Above ₦5,000,000SECTION 3: SELECT PROTECTION PLANSelect a PlanBasic Essentials Protection Plan (BESP)Flexible Seasonal Protection Plan (FSP)Daily Trade Loss Protection Plan (DTLP)Inventory Damage and Spoilage Protection Plan (IDSP)OtherCoverage Value ₦Preferred Payment FrequencyMonthlyQuarterlyAnnuallySeasonallySECTION 4: NOMINEE DETAILSNominee Name *FirstMiddleLastRelationship to ParticipantPhoneAddressSubmit Do More with Pegro Takaful Mobile App Anytime! Get It On Google Play App Store
