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Index Application Form

First Name

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Please Provide The First name

Middle Name

Last Name

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Please Provide The Last Name.

DOB

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Please Provide DOB.

Gender

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Please Select The Gender.

Marital Status

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Please Select The Marital Status.

County of Origin

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Please Enter County Name.

Nationality

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Please Enter The Nationality .

Address

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Please Enter The Address .

Phone Number

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Please Enter The Phone Number .

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Please Provide a Valid Email.

Name of Institute

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Please Enter The Name of Institute.

Enrolled Program

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Please Select The Program Enrolled.

Select Category

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Enter the Category.

Date of Entry

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Please The Date of Entry.

Wasse Certificate Number

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Please Provide Wasse Certificate Number.

Applying Date

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Please Select Applying Date.

Kin Name

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Please Provide The Next of Kin Name.

Legal Relationship

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Please Select Legal relationship.

Kin Email

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Please Provide The Valid Next of Kin Email

Kin Mobile

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Please Provide The Next of Kin Mobile.

Kin Address

Please Provide The Next of Kin Address

Payment Amount

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Please provide the payment amount.

Payment Date

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Please provide the date of payment.

Payment Proof Id

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Please provide the Payment Proof Id.

Currency

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Please Select The currency.

Payment Method

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Please Select The Payment Method.

Comments

Upload Your Birth Certificate Here

Please Upload The Birth Certificate.

Upload Your Wasse Certificate Here

Please Upload The Wasse Certificate.

Upload Your Marriage Certificate Here

Please Upload The marriage Certificate.

Upload Your Admission Letter Here

Please Upload The Admission Letter.

Upload Your Payment Proof Here

Please Upload The Payment Proof.

Upload Your License Proof Here

Please Upload The License Proof.

Upload Your Photo Here

Rules

Use a white background photograph.

Size: Width 2inch, Height 2inch.

Resolution (dpi): 300.

Size (in kb): 0-240 kb.

No sleeveless blouse.

No dangle earrings.

No wastage or long hair.

Please Upload The Profile Photo.

I hereby declare that all the information provided above are true and correct to the best of my knowledge and belief. I also understand that any discrepancy found in the above information will lead to the cancellation of application.

Please enter the code shown below: click to refresh Click the Captcha to Refresh

You should agree to the declaration.

LBNM

Index Application Form

Rules