Company Pre Registration

This is aimed at expediting the registration process when you get to the hospital. Kindly fill in all the fields to enable us complete the process at our end. You will receive a confirmation on this page if the process is successful. Give your Company Name and contact details to the registration officer when you get to the facility.

Company Pre-Registration Form

Company Name *

Address(Block # & Street Name)

Area *

Location *

Post Office Box *

Telephone *

Official Email *

Name of Contact *

Contact Person's Phone Number *

Type of Business *

Ownership Structure *

Signature (Type your name) * By typing your name, you consent that the information provided in this form is correct and accurately describes you.