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NIN Slip Template For RUBE Board

This document is an enrollment form for a National Identification Number in Nigeria. It requests personal information such as name, date of birth, addresses, and includes a declaration agreeing to share the information according to Nigerian law.

Uploaded by

Emmanuel Chibuzor
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
341 views

NIN Slip Template For RUBE Board

This document is an enrollment form for a National Identification Number in Nigeria. It requests personal information such as name, date of birth, addresses, and includes a declaration agreeing to share the information according to Nigerian law.

Uploaded by

Emmanuel Chibuzor
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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N ATIONAL IDENTIFICATION N UMBER( NIN )
E NROLMENT F ORM

* TITLE (Mr / Mrs/ Master/ Miss/ Ms):


* SURNAME:
* FIRST NAME:
MIDDLE NAME:

TOWN/CITY OF RESIDENCE……………………… COUNTRY OF RESIDENCE…………………….. STATE OF RESIDENCE…………..………….


LGA OF RESIDENCE………………………. ADDRESS OF RESIDENCE ………………………………………………………………………………..……….….
…………………………………………………………………………………………………………………………………………………………………………….……………
GENDER………………… DATE OF BIRTH…….………………………COUNTRY OF BIRTH ……………………….. STATE OF BIRTH……….……..
dd/mm/yy
LGA OF BIRTH…………………………. COUNTRY OF ORIGIN………………………………. STATE OF ORIGIN……………………………..………...
LGA OF ORIGIN…………………………………………. TOWN OF ORIGIN …………………………………………………………………………..…………..
DECLARATION /ATTESTATION
I certify that the information provided by me on this form is complete, true and accurate. I understand that the information provided by me on this form
and my biometrics shall constitute my personal information/data to be entered into the National Identity Database. I consent to sharing of my data
provided herein with any organization permitted by the NIMC Act 23 of 2007 and within the Nigerian Law. I hereby apply for a National Identification
Number (NIN) and a National Identity (Smart) Card. I accept that this form may be scanned, saved and discarded after use as the Commission may deem fit.
I understand and accept that if any information I have provided herein is not correct or is false, the Commission reserves the right of prosecution if
discovered.

Applicant’s Signature ………………………………………………………………………….. Date ………………………………………………………………………….

Applicant’s Phone Number…………………………………………………………………… BVN:………………………………………………………………………….

NOTE:
 Applicants below 15 years old must provide a copy of the NIN slip of the parent/guardian during capturing

v2.0
N ATIONAL IDENTIFICATION N UMBER ( NIN )
E NROLMENT F ORM

* TITLE (Mr / Mrs/ Master/ Miss/ Ms):


* SURNAME:
* FIRST NAME:
MIDDLE NAME:

TOWN/CITY OF RESIDENCE……………………… COUNTRY OF RESIDENCE…………………….. STATE OF RESIDENCE…………..………….


LGA OF RESIDENCE………………………. ADDRESS OF RESIDENCE ………………………………………………………………………………..……….….
…………………………………………………………………………………………………………………………………………………………………………….……………
GENDER………………… DATE OF BIRTH…….………………………COUNTRY OF BIRTH ……………………….. STATE OF BIRTH……….……..
dd/mm/yy
LGA OF BIRTH…………………………. COUNTRY OF ORIGIN………………………………. STATE OF ORIGIN……………………………..………...
LGA OF ORIGIN…………………………………………. TOWN OF ORIGIN …………………………………………………………………………..…………..
DECLARATION /ATTESTATION
I certify that the information provided by me on this form is complete, true and accurate. I understand that the information provided by me on this form
and my biometrics shall constitute my personal information/data to be entered into the National Identity Database. I consent to sharing of my data
provided herein with any organization permitted by the NIMC Act 23 of 2007 and within the Nigerian Law. I hereby apply for a National Identification
Number (NIN) and a National Identity (Smart) Card. I accept that this form may be scanned, saved and discarded after use as the Commission may deem fit.
I understand and accept that if any information I have provided herein is not correct or is false, the Commission reserves the right of prosecution if
discovered.

Applicant’s Signature ………………………………………………………………………….. Date ………………………………………………………………………….

Applicant’s Phone Number…………………………………………………………………… BVN:………………………………………………………………………….

NOTE:
 Applicants below 15 years old must provide a copy of the nin slip of the parent/guardian during capturing

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