CORPORATE OFFICE:
Marketing House
48B, Adekunle Fajuyi Way,
GRA Ikeja,
Lagos, Nigeria
Tel: 08160321503
Email: [email protected]
website: www.nimn.com.ng
PROFESSIONAL EXAMINATION ENTRY FORM Affix two (2)
recent
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STAGE…………………………………………………….STUDENT REG. NO……….....................
PREVIOUS EXAMINATION NUMBER:
(A.) SURNAME:........................................................................................................................
(PLEASE COMPLETE IN BLOCK LETTERS)
(B.) OTHER NAMES:.................................................................................................................
(C.) CONTACT ADDRESS:..........................................................................................................
(D.) TELEPHONE No:.................................. (E.) DATE OF BIRTH:..........................................
(F.) E-MAIL:.............................................. (G.) SEX:............................................................
(H.) STATE OF ORIGIN:.............................. (I.) PLACE OF PURCHASE:................................
SUBJECTS ENTERED FOR: REFERRED SUBJECTS:
PLEASE INDICATE YOUR PREFERRED EXAMINATION LAGOS KANO ENUGU IBADAN ABEOKUTA
CENTRE BY TICKING ONE OF THE ACCOMPANYING BOXES
OSHOGBO AKURE ILORIN BENIN P-HARCOURT ZARIA ABUJA CALABAR JOS OWERRI OTHERS
EXAMINATION DIET: JUNE:
YEAR
DECEMBER:
PAYMENT SHOULD BE A/C Name: NATIONAL INSTITUTE OF MARKETING OF NIGERIA
MADE INTO: A/C Number: 2012394438 Bank: First Bank of Nigeria
EDUCATIONAL QUALIFICATIONS
INSTITUTIONS ATTENDED WITH DATES
Univerisity/Polytechnic/College Month and Year Degree/Diploma, Certificate Obtained
From To
(i)
(ii)
(iii)
(iv)
(v)
PLEASE NOTE THE FOLLOWING IMPORTANT INFORMATION
1. LATE ENTRIES WILL NOT BE ACCEPTED UNDER ANY CIRCUMSTANCE.
2. ENCLOSE ALL CREDENTIALS TO SUPPORT YOUR CLAIMS
3. ATTACH TWO SELF-ADDRESSED STAMPED ENVELOPES
4. PAYMENT MADE AFTER THE CLOSING DATE WILL NOT BE PROCESSED FOR THAT EXAMINATION SESSION.
5. THE INSTITUTE WILL NOT PERMIT CANCELLATION, AMENDMENT OR DEFERRAL OF AN EXISTING
ENTRY AFTER THE PUBLISHED EXAMINATION ENTRY CLOSING DATE
6. THERE SHALL BE NO REFUND OF ANY PAYMENT MADE
7. FAILURE TO OBSERVE THESE, YOUR APPLICATION WILL BE REJECTED.
CERTIFICATION
I………………………………………………………..HEREBY CERTIFY THAT THE INFORMATION GIVEN HEREIN
ARE CORRECT TO THE BEST OF MY KNOWLEDGE. I AGREE TO ABIDE BY THE RULES AND
REGULATIONS OF THE NATIONAL INSTITUTE OF MARKETING OF NIGERIA AS CONTAINED IN THE
PROVISIONS OF THE ARTICLE AND RULES OF THE INSTITUTE.
Signature of Applicant Date of Application
FOR OFFICIAL USE ONLY
I. APPLICATION RECEIVED DATE:........................................................................................................
II. NAME OF RECEIVING OFFICER:........................................................................................................
III. SIGNATURE OF RECEIVING OFFICER:...............................................................................................
IV. NAME AND SIGNATURE OF VERIFYING OFFICER:.............................................................................
V. INDICATE IF CANDIDATES IS QUALIFIED:..........................................................................................
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