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UTME 2017 REGISTRATION FORM SAMPLE TEMPLATE (FREE)
Section 1: Designed for JAMB Candidates, by
Surname (Family Name): ______________________________________________
Attach Recent
Middle Name: _______________________________________________________
Passport Here.
First Name: _________________________________________________________
Photo should not
be older than 3
Date of Birth: _________________________
Sex: ________________________
months
Day / Month / Year
Male / Female
Disabilities: ____________________
Marital Status: ______________________
Blind / Deaf / Physical Handicap / None
Single / Married / Divorce
Postal Address: ______________________________________________________________________
Address Town: _____________________
State & Country: _________________________________
Email: _____________________________________________ Mobile Number: __________________
Nationality: _________________ State of Origin: _________________ L.G.A: __________________
Preferred State of Exam: _________________________ Exam Town: __________________________
Candidates are to note that their 1 choice can also be a College of Education, University, Innovation Enterprise
Institutes, Polytechnics/Monotechnics, NDA (Nigerian Defence Academy) or Nigeria Police Academy.
st
1
Most Preferred Institution: __________________________________________________________________
(University)
Course: _____________________________________________________________________________________
nd
2
Most Preferred Institution: __________________________________________________________________
(University/Poly/COE)
Course: _____________________________________________________________________________________
rd
3
Most Preferred Institution: __________________________________________________________________
(Poly/COE)
Course: _____________________________________________________________________________________
th
4
Most Preferred Institution: __________________________________________________________________
(COE/IEI)
Course: _____________________________________________________________________________________
PLEASE ENSURE YOU HAVE SECTION 2 OF THIS DOCUMENT. IF YOU DON’T HAVE IT, DOWNLOAD AT

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