Application Form

Application Number National Identification Number Bank Verification Number

NNR36/2024/KOG/4021/0090131 52282722691 22604671969

Category Exam State Exam Center

Sportsmen and Sportswomen Edo HQ NA SCHOOL OF SUPPLY AND
TRANSPORT ISOHOR-UGBOWO,
BENIN

Title Surname First Name

Mr UMORU MOSES

Other Name Height Religion

OJONUGWA 1.69 Christianity

Marital Status Gender Date Of Birth

Single M Friday, January 27, 2006

State of Origin LGA of Origin Mobile Number

Kogi Olamaboro 07012324085

Home Town Permanent Address

Masaka RUGA AHAJI GAMBO

Parent/ Guardian Detail

Full Name Contact Address

Usman Umoru RUGA AHAJI GAMBO

Next Of Kin

Full Name Relationship Mobile Number

Benjamin Brother 09025521897

Occupation Contact Address

Student Opposite kada model school
 Application Form
Referee Details

Referee Name Phone Referee Address

USman umoru 09158982042 Ruga AHAJI GAMBO

Usman Salome 09025521897 Masaka

Primary Details
School Qualification From To

GOVERNMENT PRIMARY SCHOOL ANAGADA LEA fslc 2006 2016

Secondary Details

School Qualification From To

GOVERNMENT PRIMARY SCHOOL ANAGADA LEA waec 2018 2023

SSCE / NECO / WASSCE / GCE

Subject Grade Examination

Mathematics B2 VERY GOOD 4231925028

English D7 PASS 4231925028

Biology C4 CREDIT 4231925028

Government B2 VERY GOOD 4231925028

Economics C4 CREDIT 4231925028

Literature-in-English C6 CREDIT 4231925028

Civic Education B3 GOOD 4231925028

Christian Religious Studies C4 CREDIT 4231925028

Commerce B3 GOOD 4231925028

Tertiary Details

Institution Course of Study Type From To Grade

 Application Form
APPLICANT'S DECLARATION

Application Number
NNR36/2024/KOG/4021/0090131

Application Number: NNR36/2024/KOG/4021/0090131

I UMORU MOSES , hereby declare that the information given in this application is true and that if found to be false I
should be prosecuted.

Signature: _______________________________ Date: _______________________________

Certification by Parents / Guardian

I _____________________________________ parent/guardian of ______________________________________, who is applying for

recruitment into the Nigerian Navy, hereby certify that I fully understand that my child/ward will (if required to) attend
the Recruitment Exercise and I shall not demand compensation or relief from the Government in respect of death or
any injury which my child/ward may sustain in the course of or as a result of any task given to him/her during the
exercise.
Parent / Guardian Witness
Name: _________________________________ Name: _________________________________
Address: _______________________________ Address: _______________________________
Signature: _______________________________ Signature: _______________________________
Date:_______________________________ Date:_______________________________
 Application Form
LOCAL GOVERNMENT AREA CERTIFICATION

Application Number
NNR36/2024/KOG/4021/0090131

Title Surname First Name

Mr UMORU MOSES

Other Name Height Religion

OJONUGWA 1.69 Christianity

Marital Status Gender Date Of Birth

Single M Friday, January 27, 2006

State of Origin LGA of Origin Mobile Number

Kogi Olamaboro 07012324085

Home Town Permanent Address

Masaka RUGA AHAJI GAMBO

Certification by LGA Chairman / Secretary Or Senior Military Officer not

below the rank of Commander or equivalent Or Chief Superintendent Of
Police from Applicant's State of Origin

I certify that the applicant ____________________________________________ is an indigene of _____________________________

L.G.A, ________________ State, and that to the best of my knowledge and belief, the facts stated on the form are correct.
I hereby declare that if any statement made in connection with this application is proven to be false I should be
prosecuted.

Name:_____________________________________________________________________
Address:________________________________________________________________________________________
Signature:_________________________________________
Date:_________________________________________
 Application Form
POLICE CERTIFICATION

Application Number
NNR36/2024/KOG/4021/0090131

Title Surname First Name

Mr UMORU MOSES

Other Name Height Religion

OJONUGWA 1.69 Christianity

Marital Status Gender Date Of Birth

Single M Friday, January 27, 2006

State of Origin LGA of Origin Mobile Number

Kogi Olamaboro 07012324085

Home Town Permanent Address

Masaka RUGA AHAJI GAMBO

Certification by LGA Chairman / Secretary Or Senior Military Officer not below the rank of
Commander or equivalent Or Chief Superintendent Of Police from Applicant's State of
Origin
I certify that the applicant ____________________________________________ is an indigene of _____________________________
L.G.A, ________________ State, and that to the best of my knowledge and belief, the facts stated on the form are correct.
I hereby declare that if any statement made in connection with this application is proven to be false I should be
prosecuted.
Name:_____________________________________________________________________
Address:________________________________________________________________________________________
Signature:_________________________________________
Date:_________________________________________
Certification by Divisional Police Officer
I certify that the applicant _________________________________ is an indigene of ______________________Town,
_________________________ L.G.A, ________________ State and that his/her parent hails from __________________________ L.G.A.
of _________________ State. That he/she has no criminal record on him/her. (If any state briefly
___________________________________________________________________________________________________________________________________
That to the best of my knowledge and belief the facts stated in the form are correct and I hereby declare that if any
statement made in connection with this application is proven to be false I should be prosecuted.

Name:_______________________________
Address:_______________________________
Signature:_______________________________
Date:_______________________________
 GUARANTOR'S FORM

Application Number
NNR36/2024/KOG/4021/0090131

Title Surname First Name

Mr UMORU MOSES

Other Name Height Religion

OJONUGWA 1.69 Christianity

Marital Status Gender Date Of Birth

Single M Friday, January 27, 2006

State of Origin LGA of Origin Mobile Number

Kogi Olamaboro 07012324085

Home Town Permanent Address

Masaka RUGA AHAJI GAMBO

Particulars of Guarantor

Surname: ______________________________________ First Name: ____________________________________

Middle Name: _________________________________ Town: _________________________________________
LGA: __________________________________________ State of Origin: ________________________________
Mobile: ________________________________________ E-mail: ________________________________________
Appointment: __________________________________ How long have you known the candidate:_______
Formation/Unit/Office Address: _________________________________________________________________
Residential Address: ___________________________________________________________________________
Contact Address: ______________________________________________________________________________
Name: ______________________________________
Address: __________________________________________________________________________
Signature:__________________________________________
Date:________________________________________

This form is to be filled by a Military Officer not below the rank of Lt Col or equivalent/Police Officer not below
the rank of Chief Superintendent of Police/Assistant Director at either Federal or State Civil Service certifying
the eligibility of the applicant. You need not to come from an applicant’s State of Origin to guarantee him/her only be
sure of the character. Please note that inability to confirm the above given information about you, will lead to
automatic disqualification of the candidate.
 Application Form
FOR OFFICIAL USE ONLY

Application Number: NNR36/2024/KOG/4021/0090131

Applicant's Full Name: UMORU MOSES
Date Received:_____________________________________
Education Qualification: Number Of Credits/Passes obtained (SSCE / GCE / WASCE / NECO):_______
Documents Attached
a)_____________________________________________________
b)_____________________________________________________
c)_____________________________________________________
d)_____________________________________________________
e)_____________________________________________________
Detailed Result
Medical fitness:_____________________________________________________
General aptitude test score:_____________________________________________________
Vocational aptitude test score:_____________________________________________________
Remark
__________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________

Rank:_____________________________________________________
Name:_____________________________________________________
Signature and Date:_____________________________________________________
Director
Rank:_____________________________________________________
Name:_____________________________________________________
Signature and Date:_____________________________________________________