Membership & Funding Application Form

FOR FUNDING (3,300,000 FCFA)

I. General Information

Membership type:

Company name or member name:

Representative's full name:

Position:

Business address:

City:

Country:

Phone / WhatsApp:

Email address:

Website (if applicable):

II. Activity Information

Business sector:

Year established:

Number of employees:

Brief description of your activities:

Date of membership application:

III. Payment Schedule

IV. General Payment Terms

Membership is valid only after payment of the first installment.
The member agrees to respect the due dates agreed with CCBA.
Any payment delay exceeding 15 days may result in suspension of membership benefits.
Payments made are non-refundable.
In case of difficulty, the member may send a written request to the General Secretariat.

V. Member Commitment

I, the undersigned , certify that I have read the present schedule and commit to respecting the agreed terms.

Signed at:

Date:

Member's signature / company stamp:

✓ Form submitted successfully! Thank you for your membership.