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Entry Fee: N5000

*Please note that you must pay the token sum of N5000 into our official bank account before completing the form... this is to avoid fake and void forms coming into our portal. Thank You.

Payment Details

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Account Name: Cal-comel Nig Ltd.

Account No: 1375647017


 

Online Entry Form

GENERAL INFORMATION
First Name(*)
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Last Name(*)
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Citizenship
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Address
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City/State
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Home Phone No
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Mobile No.
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Work Phone No.
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Email(*)
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FAMILY BACKGROUND
Father's Full Name(*)
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Father's Occupation(*)
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Photo Upload
Portrait 1(*)
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Size limit 5Mb

Full sized picture (front view)
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Size limit 5Mb

Full sized picture (rear view)
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Size limit 5Mb

MEDICAL INFORMATION
Blood Group and Genotype
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Any medical conditions we should know about?
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Any allergies or minor ailments?
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Are you on medications?
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If yes, please specify
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Have you been sick lately or undergone surgery?
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If yes, please specify
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Name of Physician
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PAYMENT DETAILS
Name of Depositor
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Slip No
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Photo (Scan and upload screenshot of payment confirmation if you paid by transfer)
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Term and Conditions Apply (Click to read)

DECLARATION OF CONTESTANT
I hereby declare that all the information stated above are true and correct to the best of my belief and knowledge, and that I have not willfully suppressed or hidden any material fact. I authorize the investigation of all statements contained in this record. I understand that an omission or misinterpretation of facts called for within will render me liable to disqualification.