Application Form
Application Number
NNR37/2024/LAG/81/0007573
National Identification Number
26430064675
Bank Verification Number
22800599225
Category
Journalist
Exam State
Lagos
Exam Center
IKEJA CANTONMENT
Title
Mr
Surname
Alli Balogun
First Name
Qauyum
Other Name
Opeyemi
Height
1.61
Religion
Islam
Marital Status
Single
Gender
M
Date Of Birth
Friday, August 5, 2005
State of Origin
Lagos
LGA of Origin
Surulere, Lagos State
Mobile Number
09137715364
Home Town
Surulere
Permanent Address
33, ONATORO STREET
Parent/ Guardian Detail
Full Name
Hassan Alli Balogun
Contact Address
33, ONATORO STREET
Next Of Kin
Full Name
Hassan Alli Balogun
Relationship
Married
Mobile Number
08035104000
Occupation
Business Man
Contact Address
33, ONATORO STREET
Application Form
Referee Details
Referee Name Phone Referee Address
Ayishat Alli Balogun O802 169 4654 33, ONATORO STREET
Owolabi Ayodele 0802 353 9723 24, Asofiyan street Mushin
Primary Details
School Qualification From To
STC College Surulere fslc 2014 2017
Secondary Details
School Qualification From To
STC College Surulere waec 2018 2023
SSCE / NECO / WASSCE / GCE
Subject Grade Examination
Mathematics C4 CREDIT 4252096033
English C6 CREDIT 4252096033
Government C5 CREDIT 4252096033
Yoruba C6 CREDIT 4252096033
Civic Education B2 VERY GOOD 4252096033
Tertiary Details
Institution Course of Study Type From To Grade
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Application Form
APPLICANT'S DECLARATION
Application Number
NNR37/2024/LAG/81/0007573
Application Number: NNR37/2024/LAG/81/0007573
I Alli Balogun Qauyum, hereby declare that the information given in this application is true and that
if found to be false I should be prosecuted.
Signature: _______________________________ Date: _______________________________
Certification 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:_______________________________
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Application Form
LOCAL GOVERNMENT AREA CERTIFICATION
Application Number
NNR37/2024/LAG/81/0007573
Title
Mr
Surname
Alli Balogun
First Name
Qauyum
Other Name
Opeyemi
Height
1.61
Religion
Islam
Marital Status
Single
Gender
M
Date Of Birth
Friday, August 5, 2005
State of Origin
Lagos
LGA of Origin
Surulere, Lagos State
Mobile Number
09137715364
:
Home Town
Surulere
Permanent Address
33, ONATORO STREET
Certification 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/LAG/81/0007573
Title
Mr
Surname
Alli Balogun
First Name
Qauyum
Other Name
Opeyemi
Height
1.61
Religion
Islam
Marital Status
Single
Gender
M
Date Of Birth
Friday, August 5, 2005
State of Origin
Lagos
LGA of Origin
Surulere, Lagos State
Mobile Number
09137715364
:
Home Town
Surulere
Permanent Address
33, ONATORO STREET
Certification 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:_________________________________________
Certification 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 briefly
____________________________________________________________________________________________________________________________
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:_______________________________
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GUARANTOR'S Certification
Application Number
NNR37/2024/LAG/81/0007573
Title
Mr
Surname
Alli Balogun
First Name
Qauyum
Other Name
Opeyemi
Height
1.61
Religion
Islam
Marital Status
Single
Gender
M
Date Of Birth
Friday, August 5, 2005
State of Origin
Lagos
LGA of Origin
Surulere, Lagos State
Mobile Number
09137715364
:
Home Town
Surulere
Permanent Address
33, ONATORO STREET
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 filled 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 confirm the above given information about you, will lead to automatic disqualification of
the candidate.
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Application Form
FOR OFFICIAL USE ONLY
Application Number: NNR37/2024/LAG/81/0007573
Applicant's Full Name: Alli Balogun Qauyum
Date Received:_____________________________________
Education Qualification: Number Of Credits/Passes obtained (SSCE / GCE / WASCE / NECO):_______
Documents Attached
a)_____________________________________________________
b)_____________________________________________________
c)_____________________________________________________
d)_____________________________________________________
e)_____________________________________________________
Detailed Result
Medical fitness:_____________________________________________________
General aptitude test score:_____________________________________________________
Vocational aptitude test score:_____________________________________________________
Remark
__________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________
Rank:_____________________________________________________
Name:_____________________________________________________
Signature and Date:_____________________________________________________
Director
Rank:_____________________________________________________
Name:_____________________________________________________
Signature and Date:_____________________________________________________
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