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UNIVERSITY OF BENIN

SCHOOL OF GRADUATE STUDIES


REFERENCE FORM
APPLICATION PIN

To be completed by candidate
(i) Name of Candidate:………………………………………………………………………………….
(surname first)

(ii) Degree in view:………………………………………………………….…….……………………


(iii) Department:…………………………………………………………………………………………
(iv) Faculty:……………………………………………………………………………………………….

To be completed by Referee

1. Name of Referee:………………………………………………………………………………………
Residential Address:……………………………………………………………………….………….
…………………………………………………………………………………………………………….
Occupation:…………………………………………………………………………….……………….
Official Status:………………………………………………………………………………………….
Remark on Candidate:…………………………………………………………………………………
…………………………………………………………………………………………………………….
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Signature:……………………………………………. Date:…………………………………………...

2. Name of Referee:………………………………………………………………………………………
Residential Address:……………………………………………………………………….………….
…………………………………………………………………………………………………………….
Occupation:…………………………………………………………………………….……………….
Official Status:………………………………………………………………………………………….
Remark on Candidate:…………………………………………………………………………………
…………………………………………………………………………………………………………….
…………………………………………………………………………………………………………….
…………………………………………………………………………………………………………….
…………………………………………………………………………………………………………….
Signature:……………………………………………. Date:…………………………………………...

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3. Name of Referee:………………………………………………………………………………………
Residential Address:……………………………………………………………………….………….
…………………………………………………………………………………………………………….
Occupation:…………………………………………………………………………….……………….
Official Status:………………………………………………………………………………………….
Remark on Candidate:…………………………………………………………………………………
…………………………………………………………………………………………………………….
…………………………………………………………………………………………………………….
…………………………………………………………………………………………………………….
…………………………………………………………………………………………………………….
Signature:……………………………………………. Date:…………………………………………...

Official Use Only

Received and Recorded by:……………………………………………………………………………..

Signature:……………………………………………Date:……………………………………………….

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