Application Form

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					           UNIVERSITY OF BENIN, BENIN CITY, NIGERIA
                             IN COLLABORATION WITH
              GENERIC TECHNOLOGY COLLEGE (UK) LTD
                           LONDON
                    ADMISSION FORM INTO DIPLOMA IN MARITIME STUDIES,
                      INFORMATION AND COMUNICATION TECHNOLOGY.




                                                            Passport Photograph

PERSONAL DATA
First Name
Middle Name
Surname
Date of Birth (dd/mm/yyyy)
Local Government Area
State of Origin
Nationality
Email
Phone
Postal Address




Residential Address




Next of Kin Address




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 QUALIFICATION
 First Sitting
 Exam Type
 Full Name
 Exam Number
 Exam Date (dd/mm/yyyy)
 Results




 Second Sitting
 Exam Type
 Full Name
 Exam Number
 Exam Date (dd/mm/yyyy)
 Results




 Experience (If any)




 Mode of Sponsorship
 Date of Application
 Date of Entrance
 Examination
 Venue of Examination
 Time

The applicant has confirmed that the picture shown on this slip is a true picture of him/her.

Send scanned copy of this application form and bank teller as email attachment to
admin@unibengtc.com or unibengtc@uniben.edu.ng

Come with writing materials, original copy of this application form and bank payment teller to the
examination center.

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