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JOINT ADMISSIONS AND MATRICULATION BOARD

2019 UTME REGISTRATION FORM TEMPLATE


(FOREIGN CENTRES)
RECENT PASSPORT
PHOTOGRAPH NOT
Surname First Name Middle Name OLDER THAN 3
Date of Birth: Sex (Male or Female): MONTHS
dd/mm/yyyy
Marital Status: Disabilities (Blind/Deaf/Physical Handicap):

Postal Address:
Address Town State/Country

Email Address: GSM Number:

Nationality (Nigerian/Non Nigerian):

State of Origin: Local Govt.:

UTME Subjects:

1. Use of English 3.
2. 4.

First Choice

Degree Type: (NCE/ND/Degree/IEI)

Institution:

Course:

Second Choice

Degree Type: (NCE/ND/ Degree /IEI)

Institution:

Course:
Third Choice

Degree Type: (NCE/ND/ Degree /IEI)

Institution:

Course:

Fourth Choice

Degree Type: (NCE/ND/ Degree /IEI)

Institution:

Course:
O’ level Result:

No of Sitting(s):

S/N Subject Exam Type Year Grade Examination No.

Candidate’s Sign/Date:

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