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ESMSC STAFF DATA CAPTURE PORTAL
PLEASE COMPLETE THE FORM WITH YOUR ACCURATE INFORMATION
*EMPLOYEE NO
*SURNAME
*FIRSTNAME
OTHER NAMES
*GENDER
.
Male
.
Female
*MARITAL STATUS
.
Married
.
Single
*DATE OF BIRTH
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*STATE OF ORIGIN
--- Select ---
Abia
Adamawa
Akwa Ibom
Anambra
Bauchi
Bayelsa
Benue
Borno
Cross River
Delta
Ebonyi
Edo
Ekiti
Enugu
FCT
Gombe
Imo
Jigawa
Kaduna
Kano
Katsina
Kebbi
Kogi
Kwara
Lagos
Nasarawa
Niger
Ogun
Ondo
Osun
Oyo
Plateau
Rivers
Sokoto
Taraba
Yobe
Zamfara
*RESIDENTIAL ADDRESS
*STATE OF RESIDENCE
--- Select ---
Abia
Adamawa
Akwa Ibom
Anambra
Bauchi
Bayelsa
Benue
Borno
Cross River
Delta
Ebonyi
Edo
Ekiti
Enugu
FCT
Gombe
Imo
Jigawa
Kaduna
Kano
Katsina
Kebbi
Kogi
Kwara
Lagos
Nasarawa
Niger
Ogun
Ondo
Osun
Oyo
Plateau
Rivers
Sokoto
Taraba
Yobe
Zamfara
*OFFICE LOCATION
PERSONAL PHONE
STAFF LINE
PERSONAL EMAIL
OFFICIAL EMAIL
*DATE OF ASSUMPTION
*DEPARTMENT
*DESIGNATION
*BANK NAME
--- Select ---
9 Payment Service Bank (9PSB)
Access Bank Plc
Fidelity Bank Plc
First City Monument Bank Limited
First Bank of Nigeria Limited
Guaranty Trust Holding Company Plc
Union Bank of Nigeria Plc
United Bank for Africa Plc
Zenith Bank Plc
Citibank Nigeria Limited
Ecobank Nigeria
Keystone Bank Limited
Optimus Bank Limited
Polaris Bank Limited
Stanbic IBTC Bank Plc
Standard Chartered
Sterling Bank Plc
Titan Trust Bank Limited
Unity Bank Plc
Wema Bank Plc
Globus Bank Limited
Parallex Bank Limited
PremiumTrust Bank Limited
Providus Bank Limited
SunTrust Bank Nigeria Limited
Signature Bank Limited
Jaiz Bank Plc
Lotus Bank
TAJBank Limited
*BANK ACCOUNT NO
*PFA
--- Select ---
STANBIC IBTC PENSION MANAGERS LIMITED
PREMIUM PENSION LIMITED
LEADWAY PENSURE PFA LIMITED
SIGMA PENSIONS LIMITED
PENSIONS ALLIANCE LIMITED
ARM PENSION MANAGERS (PFA) LIMITED
TRUSTFUND PENSIONS PLC
FIRST GUARANTEE PENSION LIMITED
FCMB PENSION (FORMERLY AIICO PENSION AND LEGACY PENSION)
NLPC PENSION FUND ADMINISTRATORS LIMITED
CRUSADERSTERLING PENSIONS LIMITED
FCMB PENSION (FORMERLY AIICO PENSION AND LEGACY PENSION)
OAK PENSIONS LIMITED
AXA MANSARD PENSIONS LIMITED
NORRENBERGER PENSION (FORMERLY IEI-ANCHOR)
APT PENSION FUNDS MANAGERS LIMITED
FUTURE UNITY GLANVILLS PENSIONS LIMITED
FIDELITY PENSION MANAGERS LIMITED
GUARANTY TRUST PENSION MANAGERS
CITI TRUST PENSION FUND MANAGERS LIMITED
ACCESS PENSION LIMITED
RADIX PENSION MANAGERS LIMITED
PIN NO.
TIN NO / TAXPAYER ID
NHF NO.
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GUARANTORS NAME
GUARANTOR ADDRESS
GUARANTORS PHONE
*NAME OF NEXT OF KIN
*NEXT OF KIN ADDRESS
*NEXT OF KIN PHONE
Beneficiary 1 Name
Beneficiary 1 Phone No
Beneficiary 2 Name
Beneficiary 2 Phone No
Beneficiary 3 Name
Beneficiary 3 Phone No
Beneficiary 4 Name
Beneficiary 4 Phone No
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*PASSPORT PHOTOGRAPH
(File Type: JPEG, JPG) | File Size: Max 1MB
gif,jpg,jpeg,png,psd,tif,tiff
*BIRTH CERTIFICATE OR AGE DECLARATION
File Type: PDF (1MB)
X
doc,docx,mpg,mpeg,mp3,mp4,odt,odp,ods,pdf,ppt,pptx,txt,xls,xlsx
NYSC CERTIFICATE
File Type: PDF (1MB)
X
doc,docx,mpg,mpeg,mp3,mp4,odt,odp,ods,pdf,ppt,pptx,txt,xls,xlsx
LAST 2 HIGHEST QUALIFICATIONS
File Type: PDF (1MB)
X
doc,docx,mpg,mpeg,mp3,mp4,odt,odp,ods,pdf,ppt,pptx,txt,xls,xlsx
MARRIAGE CERTIFICATE
File Type: PDF (1MB)
X
doc,docx,mpg,mpeg,mp3,mp4,odt,odp,ods,pdf,ppt,pptx,txt,xls,xlsx
*BENEFICIARY FORMS
File Type: PDF (1MB)
X
doc,docx,mpg,mpeg,mp3,mp4,odt,odp,ods,pdf,ppt,pptx,txt,xls,xlsx
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