Application Form
Application Number
NNR37/2024/IMO/184/0020060
National Identi cation Number
53369055020
Bank Veri cation Number
22752665423
Category
Drivers/Mechanics - H
Exam State
Kogi
Exam Center
CAR LOKOJA
Title
Mr
Surname
Chukwudi
First Name
David
Other Name
Height
1.69
Religion
Christianity
Marital Status
Single
Gender
M
Date Of Birth
Sunday, May 5, 2002
State of Origin
Imo
LGA of Origin
Ngor Okpala
Mobile Number
08132583304
Home Town
Minna
Permanent Address
Keteren gwari minna niger state
Parent/ Guardian Detail
Full Name
Chukwudi Vincent
Contact Address
Keteren gwari minna niger state
Next Of Kin
Full Name
Chukwudi Vincent
Relationship
Father
Mobile Number
0803 687 5032
Occupation
Mechanical engineering
Contact Address
SW383 keteren gwari minna niger state
Application Form
Referee Details
Referee Name Phone Referee Address
Samuel Vincent 08105743693 Keteren gwari minna niger state
Favour chukwudi 08130118886 Keteren gwari minna niger state
Primary Details
School Quali cation From To
Dr umar faruk primary school minna fslc 2009 2015
Secondary Details
School Quali cation From To
Dr umar faruk primary school minna nabteb 2017 2022
SSCE / NECO / WASSCE / GCE
Subject Grade Examination
Mathematics C4 CREDIT 2
English A1 EXCELLENT 1
Physics A1 EXCELLENT 4
Chemistry C4 CREDIT 5
Biology C4 CREDIT 6
Geography A1 EXCELLENT 8
Agricultural Science A1 EXCELLENT 7
Economics C4 CREDIT 3
Computer Craft F9 FAIL 9
Tertiary Details
Institution Course of Study Type From To Grade
Institution Course of Study Type From To Grade
Application Form
APPLICANT'S DECLARATION
Application Number
NNR37/2024/IMO/184/0020060
Application Number: NNR37/2024/IMO/184/0020060
I Chukwudi David , hereby declare that the information given in this application is true and that if found to be
false I should be prosecuted.
Signature: _______________________________ Date: _______________________________
Certi cation by Parents / Guardian
I _____________________________________ parent/guardian of ______________________________________, who is applying
for recruitment into the Nigerian Navy, hereby certify that I fully understand that my child/ward will (if required
to) attend the Recruitment Exercise and I shall not demand compensation or relief from the Government in
respect of death or any injury which my child/ward may sustain in the course of or as a result of any task given
to him/her during the exercise.
Parent / Guardian Witness
Name: _________________________________ Name: _________________________________
Address: _______________________________ Address: _______________________________
Signature: _______________________________ Signature: _______________________________
Date:_______________________________ Date:_______________________________
Application Form
LOCAL GOVERNMENT AREA CERTIFICATION
Application Number
NNR37/2024/IMO/184/0020060
Title
Mr
Surname
Chukwudi
First Name
David
Other Name
Height
1.69
Religion
Christianity
Marital Status
Single
Gender
M
Date Of Birth
Sunday, May 5, 2002
State of Origin
Imo
LGA of Origin
Ngor Okpala
Mobile Number
08132583304
Home Town
Minna
Permanent Address
Keteren gwari minna niger state
Certi cation by LGA Chairman / Secretary Or Senior Military O cer not
below the rank of Commander or equivalent Or Chief Superintendent
Of Police from Applicant's State of Origin
I certify that the applicant ____________________________________________ is an indigene of
_____________________________ L.G.A, ________________ State, and that to the best of my knowledge and belief, the
facts stated on the form are correct. I hereby declare that if any statement made in connection with this
application is proven to be false I should be prosecuted.
Name:_____________________________________________________________________
Address:________________________________________________________________________________________
Signature:_________________________________________
Date:_________________________________________
Application Form
POLICE CERTIFICATION
Application Number
NNR37/2024/IMO/184/0020060
Title
Mr
Surname
Chukwudi
First Name
David
Other Name
Height
1.69
Religion
Christianity
Marital Status
Single
Gender
M
Date Of Birth
Sunday, May 5, 2002
State of Origin
Imo
LGA of Origin
Ngor Okpala
Mobile Number
08132583304
Home Town
Minna
Permanent Address
Keteren gwari minna niger state
Certi cation by LGA Chairman / Secretary Or Senior Military O cer not below the
rank of Commander or equivalent Or Chief Superintendent Of Police from Applicant's
State of Origin
I certify that the applicant ____________________________________________ is an indigene of
_____________________________ L.G.A, ________________ State, and that to the best of my knowledge and belief, the
facts stated on the form are correct. I hereby declare that if any statement made in connection with this
application is proven to be false I should be prosecuted.
Name:_____________________________________________________________________
Address:________________________________________________________________________________________
Signature:_________________________________________
Date:_________________________________________
Certi cation by Divisional Police O cer
I certify that the applicant _________________________________ is an indigene of ______________________Town,
_________________________ L.G.A, ________________ State and that his/her parent hails from __________________________
L.G.A. of _________________ State. That he/she has no criminal record on him/her. (If any state brie y
____________________________________________________________________________________________________________________________
That to the best of my knowledge and belief the facts stated in the form are correct and I hereby declare that if
any statement made in connection with this application is proven to be false I should be prosecuted.
Name:_______________________________
Address:_______________________________
Signature:_______________________________
Date:_______________________________
GUARANTOR'S Certi cation
Application Number
NNR37/2024/IMO/184/0020060
Title
Mr
Surname
Chukwudi
First Name
David
Other Name
Height
1.69
Religion
Christianity
Marital Status
Single
Gender
M
Date Of Birth
Sunday, May 5, 2002
State of Origin
Imo
LGA of Origin
Ngor Okpala
Mobile Number
08132583304
Home Town
Minna
Permanent Address
Keteren gwari minna niger state
Particulars of Guarantor
Surname: ______________________________________ First Name: ____________________________________
Middle Name: _________________________________ Town: _________________________________________
LGA: __________________________________________ State of Origin: ________________________________
Mobile: ________________________________________ E-mail: ________________________________________
Appointment: __________________________________ How long have you known the candidate:_______
Formation/Unit/O ce Address: _________________________________________________________________
Residential Address: ___________________________________________________________________________
Contact Address: ______________________________________________________________________________
Name: ______________________________________
Address: __________________________________________________________________________
Signature:__________________________________________
Date:________________________________________
This form is to be lled by a Military O cer not below the rank of Lt Col or equivalent/Police O cer not
below the rank of Chief Superintendent of Police/Assistant Director at either Federal or State Civil
Service certifying the eligibility of the applicant. You need not to come from an applicant’s State of Origin to
guarantee him/her only be sure of the character. Please note that inability to con rm the above given
information about you, will lead to automatic disquali cation of the candidate.
Application Form
FOR OFFICIAL USE ONLY
Application Number: NNR37/2024/IMO/184/0020060
Applicant's Full Name: Chukwudi David
Date Received:_____________________________________
Education Quali cation: Number Of Credits/Passes obtained (SSCE / GCE / WASCE / NECO):_______
Documents Attached
a)_____________________________________________________
b)_____________________________________________________
c)_____________________________________________________
d)_____________________________________________________
e)_____________________________________________________
Detailed Result
Medical tness:_____________________________________________________
General aptitude test score:_____________________________________________________
Vocational aptitude test score:_____________________________________________________
Remark
__________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________
Rank:_____________________________________________________
Name:_____________________________________________________
Signature and Date:_____________________________________________________
Director
Rank:_____________________________________________________
Name:_____________________________________________________
Signature and Date:_____________________________________________________
