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NIN Enrollment Form Instructions

This document is an enrolment form for obtaining a National Identification Number (NIN) in Nigeria. It requires personal details, contact information, and demographic data, including height, education level, and employment status. The applicant must certify the accuracy of the information provided and consent to data sharing as per Nigerian law.

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ikwegbuec
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284 views2 pages

NIN Enrollment Form Instructions

This document is an enrolment form for obtaining a National Identification Number (NIN) in Nigeria. It requires personal details, contact information, and demographic data, including height, education level, and employment status. The applicant must certify the accuracy of the information provided and consent to data sharing as per Nigerian law.

Uploaded by

ikwegbuec
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

M

Nünc
Providing assured identity

DEMOGRAPHIC DATA
NATIONAL IDENTIFICATION NUMBER (NIN)
ENROLMENT FORM
PLEASE FILL THE FORM IN BLOCK LETTERS AND TICK AS APPROPRIATE

Personal Details
Title* Surname* First Name*

Middle Name Other Names Maiden Name

Gender* Marital Status Date of Birth (Day - Month-Year) *


Male Divorced Married Separated DD MM YYYY

Female Single widowed


Country of Birth* Nationality *

Contact Details
Telephone Number * Email Address

Address Details
Residence Status * Address line 1 *

Birth LNaturalization
Registration
Address line 2 Town/City * Country *

State/Province * LGA/Country * Postal/Zip Code

Place of Origin Details


Country of Origin * State of Origin * Town/City of Origin

LGAof Origin *
Other Details
Height (cm) * Date of Birth - Verification Religion *
Verified Approximate Christian Islam

Declared Traditional Other O


Highest Levelof Education * Employment Status Occupation/Profession *
Certification Primary Secondary Employed UnemployedL
Tertiary Post-GraduateNonel PensionerLUSelf-Employed

Applicable To New Child Enrolment: Parent/ Guardian Details


Parent/ Guardian Surname * Parent/ Guardian First Name * Parent/ Guardian NIN *

Previous Name Detail


Previous Surname
Previous Middle Names
Previous First Name

Physical Features and Attributes


Physical Features Disability

Applicant Card Data


Card Type * Issuing Bank *

Applicant Document
Document expiry Date Document Number
Document Type

DECLARATION/ATTESTATION
I certify that the information provided by me on this form is complete, true and accurate. Iunderstand that the information provided by me on this
form and my biometrics shall constitute my personal information/data to be entered into the National ldentity Database. Iconsent to sharing of my
data herein with any organization permitted by the NIMC Act 23 of 2007 and within the Nigerian Law. I hereby apply for a National
provided Number
Identification (NIN)and a National ldentity (Smart) Card. Iaccept that this form may be scanned, saved and discarded after use as the
Commission may deem fit. Iunderstand and accept that if any information Ihave provided herein is not correct or is false, the Commission reserves
the right of prosecution if discovered.
Signature/ Date

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