PROGRAMME

National Diploma (Full Time) REG. NUM. : COURSE : UTM15030 Accountancy

2012/2013 ADMISSION APPLICATION FORM SECTION A

1. Surname: 2. Other Name(s): 3. Sex: 5. Nationality: 7. Home Town: 9. Marital Status: 11. Home address: FAGBAMILA Oluwatoyin Oluwakemi Female Nigerian IKOGOSI Single 4. Date of birth: 6. State of origin: 8. Local Govt. Area: 10. Religion: 28 Jan, 1991 Ekiti Ekiti West Christianity

SW8/1143B OGUNLEYE AVENUE,LIBERTY ROAD,IBADAN.

SECTION B
GCE -

SECTION C
U.T.M.E. DETAILS

1. Maths 2. English 3. Accounts 4. Agric Sci. 5. Commerce 6. Economics 7. Biology 8. Geography 9. Yoruba Exam no.: 5140401004 Date: Aug 2012

AR AR AR AR AR AR AR AR AR

1. 2. 3. 4. 5. 6. 7. 8. 9. Exam no.: Date: - -

List of Schools Chosen 1. University of Ado-Ekiti 2. Tai Solarin University of Education, Ijebu-Ode 3. Fed. Poly., Ede 4. The Polytechnic, Ibadan 5. Oyo State College of Education, Oyo 6. Oyo State College of Education, Oyo U.T.M.E. Number : 26390448FG U.T.M.E. Score : 211

SECTION D Particulars of parent/guardian/next of kin

(a). (b). (c). (d). Name: Address: Relationship: Telephone: MR FAGBAMILA JACOB SW8/1143B OGUNLEYE AVENUE,LIBERTY ROAD,IBADAN. FATHER 08132557579

Sponsor
(a). (b). Name: Address: MR FAGBAMILA JACOB SW8/1143B OGUNLEYE AVENUE,LIBERTY ROAD,IBADAN., 08132557579

DECLARATION
I declare that the information stated above is, to the best of my knowledge and belief, accurate in every detail; and if at any time it is discovered that the information I have given is false or incorrect, I will be required to withdraw or be liable to prosecution or both; and that if I am admitted, I shall keep to the rules of the institution. Signature: ______________________ Date: 20 Jun, 2012
2012, www.federalpolyede.edu.ng