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Citizens’ Registration

Citizens' Registration:

SECTION A - PERSONAL DATA

Instructions: Fill all information required on the form below.
Last Name: *
First Name: *
Initials /Other Names: *
Maiden Name:
Contact Address: *
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Telephone Number: *
Facsimile Number:
Mobile Phone: *
Email Address: *Please, use a valid email address; for you will be contacted through the email.

SECTION B - PASSPORT INFORMATION

Date Of Birth: *
Passport Number: *
Date Issue: *
Place Of Issue: *

SECTION C - OTHER INFORMATION

Sex *
FemaleMale
Marital Status: *
MarriedSingle
Height (Ft/M):
Blood Group:
Employer:
Other Medical Condition: (In Case Of Emergency) *

SECTION D - EDUCATION INFORMATION

Profession:
Educational Qualification(s) With Date(s):

SECTION E - EMPLOYMENT INFORMATION (OPTIONAL)

Contact Address: *
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Mobile Phone:

SECTION F - NEXT OF KIN'S DATA

Instructions: FILL UP YOUR NEXT OF KIN INFORMATION IN ETHIOPIA
Full Name: *
Relationship: *
Contact Address:
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Telephone: *
Instructions: FILL UP YOUR NEXT OF KIN INFORMATION IN NIGERIA
Full Name: *
Relationship: *
Contact Address: *
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Telephone: *

SECTION G - PERMANENT ADDRESS IN NIGERIA

Contact Address: *
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Mobile Phone: *

Verification

Please enter any two digits *Example: 12
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