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NOT FOR SALE.

DO NOT PAY FOR THE TEMPLATE


UTME 2024 REGISTRATION TEMPLATE
A ESSENTIAL INFORMATION
(MUST AGREE WITH NIMC)YES NO PROFILECODE:
PIN:

Surname: First Name:


Middle Name: Date of Birth: Sex:
Marital Status: Maiden Name if Married: Previous Name:

Mobile Number:

Nationality: State of Origin: L.G.A:


B OTHER INFORMATION
Disabilities/Challenges: Blind Deaf Dumb Albino Lame Others None
Contact Address: ______________________________
Preferred State of Exam: Exam Town: Interested in JAMB Mock Exam: YES NO
C CHOICES OF INSTITUTION
Candidates are to NOTE that their 1st choice can also be a College of Education, University, Innovation
Enterprise Institute, Polytechnic/Monotechnic, NDA (Nigerian Defence Academy) or Nigeria Police Academy.
1st Choice (Degree/ND/NCE): _____________________________________________________________________
Programme of study: ___________________________________________________________________________
2nd Choice (Institution): _________________________________________________________________________
Programme of study: ___________________________________________________________________________
3rd Choice (Institution): __________________________________________________________________________
Programme of study: ____________________________________________________________________________
4th Choice (Institution): _________________________________________________________________________
Programme of study:

D UTMESUBJECTS
1. USE OF ENGLISH 2.
3. 4.

E O’LEVEL INFORMATION
NAME OF SECONDARY SCHOOL ATTENDED:
O’LEVELSUBJECTS GRADE WAEC,NECO,NABTEB SCHOOL/PRIVATE YEAR EXAMNOs
1.
2.
3.
4.
5.
6.
7.
8.
9.

I supplied the above information. Signature &Date:

FOR STAFF ONLY

Processed by:__________________________________________ Signature & Date:

Remark:

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