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Balogun Abisoye Part-Time Candidates

This document contains a candidate's personal details and academic information submitted for admission consideration. It includes the candidate's name, date of birth, gender, contact information, nationality, institution and program details, matriculation information, proposed graduation details, and signatures from the candidate and head of institution to verify the information and indemnify the processing body against inaccuracies. The document is for office use to review and note the status of the admission request.

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otusanyajoshua03
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116 views1 page

Balogun Abisoye Part-Time Candidates

This document contains a candidate's personal details and academic information submitted for admission consideration. It includes the candidate's name, date of birth, gender, contact information, nationality, institution and program details, matriculation information, proposed graduation details, and signatures from the candidate and head of institution to verify the information and indemnify the processing body against inaccuracies. The document is for office use to review and note the status of the admission request.

Uploaded by

otusanyajoshua03
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Reg.

(ITS) No: 007P


*REFERENCE NUMBER:
CANDIDATE PERSONAL DETAILS
*SURNAME:

*FIRST NAME: MIDDLE NAME:

*DATE OF BIRTH: *GENDER: *MARITAL STATUS:

*PHONE: *EMAIL:

*CONTACT ADDRESS:

*NATIONALITY: *STATE OF ORIGIN:

*YEAR OF ENROLMENT:

*NAME OF INSTITUTION WHICH ENROLED YOU:


*CURRENT PROGRAMME (COURSE) NAME:

MATRICULATION NUMBER: YEAR OF MATRICULATION:

YEAR OF GRADUATION (PAST OR IN VIEW):

SERIAL NUMBER ON THE GRADUATING LIST OF STUDENTS:

NAME OF HEAD OF INSTITUTION:

NAME OF REGISTRAR:

……………………………………………………………………………………………………………………………………

Candidate’s Signature/Date
INDEMNITY: To be given (completed) by the Head of Institution
I confirm the facts above and hereby indemnify JAMB against any inaccuracy of the claims contained therein.
I affirm that if JAMB approves the Application for Admission of this Part-Time candidate, we will correct our record accordingly
NAME OF HEAD OF INSTITUTION: ………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………….
Head of Institution’s Signature/Date/Stamp

OFFICE USE
Name of JAMB Staff…………………………………………………………………………………………………………………………………………………………………………………………………………
Department/Unit…………………………………………………………………………………………………………………………………………………………………………………………………………….
Status of Request (Approved/Not Approved)…………………………………………………………………………… .................................................................
Date/Sign

NOTE:
1. The candidate pays a penalty of N5000 in addition to what he/she ought to have paid if he/she had processed legitimate application;
2. The indemnity is auto generated for indemnity by Institution;

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