ANGNASUURI DOMINIC

DOCTOR OF MEDICAL LABORATORY SCIENCE

ALLIED HEALTH PROFESSIONS

COUNCIL
MINISTRY OF HEALTH

APPLICATION FORM FOR PROVISIONAL

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1. A completed application form
2. Certified Photocopy of picture National ID
3. Certified evidence of any change of name (if applicable)
4. Expired PIN Card
5. One Passport-size photograph (red background)

Personal Profile

Gender: House Number:

Male ZPJ-0035

Telephone: Street Name:

0550951215 ST. FRANCIS GIRLS SHS

Dr DOMINIC Email Address: Locality:

ANGNASUURI angnasuurid@gmail.com ZAKPAAYIR

(DOCTOR OF MEDICAL
LABORATORY SCIENCE) Date of Birth: District:
7th Jul, 1995 Jirapa Municipal
AHPC PIN: 68576923
Place of Birth: Region:
Level: Degree JIRAPA Upper West Region

Nationality: Marital Status:

Ghana Single
Identification
IDENTIFICATION TYPE NUMBER FILE(S)
ANGNASUURI DOMINIC
DOCTOR OF MEDICAL LABORATORY SCIENCE

Ghana Card GHA-723382451-1

Institution(s) Attended
INSTITUTION NAME YEAR PROGRAM OF STUDY CERTIFICATE
DURATION

UNIVERSITY FOR Doctor of Medical

2017 - 2023
DEVELOPMENT STUDIES Laboratory Science

Referees
NAME EMAIL ADDRESS ADDRESS PHONE APPROVAL
NUMBER

KAFONGDALA
ullok.joseph@gmail.com Wa 0256702829 APPROVED
JOSEPH ULLO

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ANGNASUURI DOMINIC
DOCTOR OF MEDICAL LABORATORY SCIENCE
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