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COPAM
October 2018 in Zagoué
Membership to COPAM
Mr. (*)
Miss, Mrs(*)
Code
*
:
name
*
:
First names
*
:
Nationality
*
:
Choisir
Ivoirienne
Marocainne
Birth date
*
:
Place of birth
*
:
Situat. Matri.
*
:
Choisir
Célibataire
Marié
Veuf(ve)
Divorcé(e)
Children's nber
*
:
subscription date
*
:
Acting individually
Acting on behalf of a corporation;
SARL
SA
SNC
Coopérative
Other Specify
Social reason :
:
PROFESSIONAL
HOME
Address : :
Town : :
*
Nο Phone : :
Nο Phone : :
Nο fax :
Nο fax :
Nο portable :
Nο portable :
Email :
*
Nο CC :
Trade register :
Nο Piece of identity :
Register SC :
Secondary activities :
Main activities :
Date of creation of the company :
:
Type of adhesion :
*
first registration
re-inscritpion
comes from a cooperative **
Name, place and date membership / cancellation at this cooperative :
:
Number of shares
*
:
Photo of the adherent :
: