NSS ENROLMENT FORM

NSS Number : NSSAHC9253623

PIN: HGPAHC9326523
National ID Ghana Card
ID Number GHA-723382451-1
PERSONAL INFORMATION
NAME ON NATIONAL ID
ANGNASUURI DOMINIC
:
Surname: ANGNASUURI Other Names : DOMINIC
Name Of Institution: Course Of Study: DOCTOR OF MEDICAL LABORATORY SCIENCE
Sex: Male Date of Birth: 7-7-1995
Marital Status : Single Nationality : Ghana
Contact Tel No.(s) : +233550951215 Email Address : angnasuurid@gmail.com
Residential Address : Jirapa
Ghana GPS Digita Address : XJ-0087-7092: Residential Region UPPER WEST
GUARDIAN INFORMATION
Guardian Name : Angnasuuri Dorothy
Guadian Email : Guadian Phone No +233555578980
NEXT OF KIN INFORMATION
Name of Next of Kin: Anagnasoori Pachal Kin's Contact No. : +233549322492
Relationship: Brother
EMPLOYMENT HISTORY & OTHER INFORMATION
Are you currently employed? No Study Leave Type:
The Organization you work with(Your Study Leave Sponsor):
Organization Phone #:
Do you have any health condition? No Health Condition Type:
Health Condition Details:
Do you have Military Training?* No Have you done Service Before*: No
Organization you have served before:
POSTING PREFERENCES INFORMATION
Region I: ASHANTI Region II: BONO EAST Region III: NORTHERN
INDUSTRIAL PREFERENCE - SERVICE OPTION
Service Option I:: Community Health Service Option II: Private Sector Entrepreneurship Type: