Madap Wallet Card UnionHouse Tier-Level Membership Offline Registration Form

For applicants who prefer paper registration.

Complete this form clearly, attach all required supporting documents, and email it to support@madapwalletcard.com.ng.

Surname *

First name *

Middle name *

Date of birth *

Phone number *

Occupation *

State *

LGA *

Tax ID (TIN)

Identification type *

ID number *

BVN *

ID issue date *

ID expiry date *

Bank allocation *

Security Question *

Security Answer *

Terms and Conditions Terms and Conditions for Tier-Level Membership You have 30 minutes to complete this registration after the timer starts. A synchronized countdown is displayed through every phase. Phase 1 requires email and password account creation plus a 6-digit OTP that expires after 10 minutes. Once verified, the OTP does not need to be requested again during the same session. This form track is strictly for a single individual applicant and contains personal profile fields only. All submitted information must be accurate, current, and owned by the applicant or business being registered. Applicants in the Tier-Level Membership track must be at least 18 years old. Mandatory banking allocation is handled through 9Payment Service Bank (9PSB) or Adike MFB. Payment instructions and the payment support link are displayed immediately after successful submission. By continuing, you agree to identity checks, age validation, OTP verification, payment processing, and secure session tracking.

Applicant signature

Date