Jamb Regularization – WESTLAND POLYTECHNIC ILOBU

PERSONAL DETAILS

Affix
a recent
passport
photo

Name*

Surname First Name Other Name

Department*

Matric No*

Year of Admission*

Phone Number*

Gender*

Email*

Date of Birth*

JAMB DETAILS

Have you done JAMB before?*

Yes
No

If Yes,

Year _________________________ Centre No _________________________ Registration number _______________________________________

Admission Status*

Conditional
Provisional

I {Name (First):1.3} {Name (Middle):1.4} hereby agreed that all the above details are for me and if found otherwise, I should be denied regularization.

__________________________________________
Student Signature and Date

FOR OFFICIAL USE ONLY

Jamb regularization code ________________________________________________________
Officer in charge's name _________________________________________________________

__________________________________________
Signature, Stamp and Date