Application Form

Application Number National Identification Number Bank Verification Number

NNR37/2024/KAT/1361/0028023 33068865164 22714270180

Category Exam State Exam Center

Seaman Kastina 35 BN KATSINA

Title Surname First Name

Mr MUSA AHMAD

Other Name Height Religion

1.72 Islam

Marital Status Gender Date Of Birth

Single M Tuesday, September 21, 2004

State of Origin LGA of Origin Mobile Number

Katsina Kankara 07013179426

Home Town Permanent Address

Kankara DANDUTSE KANKARA

Parent/ Guardian Detail

Full Name Contact Address

MUSA UMAR DANDUTSE KANKARA

Next Of Kin

Full Name Relationship Mobile Number

MUSA UMAR Father 08024972217

Occupation Contact Address

CIVIL SERVANT DANDUTSE
 Application Form
Referee Details

Referee Name Phone Referee Address

MUNTARI MUSA 07088688031 DANDUTSE KANKARA

ABDULAZIZ MUSA 08140502956 DANDUTSE KANKARA

Primary Details
School Qualification From To

SHEIKH ABUBAKAR MAHMUD GUMI PRIMARY SCHOOL fslc 2010 2016

KANKARA

Secondary Details

School Qualification From To

GOVERNMENT SENIOR SECONDARY SCHOOL, ZANGON- neco 2017 2022

PAUWA

SSCE / NECO / WASSCE / GCE

Subject Grade Examination

Mathematics C4 CREDIT 2210399843CF

English C6 CREDIT 2210399843CF

Biology C6 CREDIT 2210399843CF

Hausa C4 CREDIT 2210399843CF

Islamic Studies C5 CREDIT 2210399843CF

Animal Husbandry C6 CREDIT 2210399843CF

Tertiary Details

Institution Course of Study Type From To Grade

 Application Form
APPLICANT'S DECLARATION

Application Number
NNR37/2024/KAT/1361/0028023

Application Number: NNR37/2024/KAT/1361/0028023

I MUSA AHMAD, 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:_______________________________
 Application Form
LOCAL GOVERNMENT AREA CERTIFICATION

Application Number
NNR37/2024/KAT/1361/0028023

Title Surname First Name

Mr MUSA AHMAD

Other Name Height Religion

1.72 Islam

Marital Status Gender Date Of Birth

Single M Tuesday, September 21, 2004

State of Origin LGA of Origin Mobile Number

Katsina Kankara 07013179426

Home Town Permanent Address

Kankara DANDUTSE KANKARA

Certification by LGA Chairman / Secretary Or Senior Military Officer 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/KAT/1361/0028023

Title Surname First Name

Mr MUSA AHMAD

Other Name Height Religion

1.72 Islam

Marital Status Gender Date Of Birth

Single M Tuesday, September 21, 2004

State of Origin LGA of Origin Mobile Number

Katsina Kankara 07013179426

Home Town Permanent Address

Kankara DANDUTSE KANKARA

Certification by LGA Chairman / Secretary Or Senior Military Officer 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 Officer
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:_______________________________
 GUARANTOR'S Certification

Application Number
NNR37/2024/KAT/1361/0028023

Title Surname First Name

Mr MUSA AHMAD

Other Name Height Religion

1.72 Islam

Marital Status Gender Date Of Birth

Single M Tuesday, September 21, 2004

State of Origin LGA of Origin Mobile Number

Katsina Kankara 07013179426

Home Town Permanent Address

Kankara DANDUTSE KANKARA

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/Office Address: _________________________________________________________________
Residential Address: ___________________________________________________________________________
Contact Address: ______________________________________________________________________________
Name: ______________________________________
Address: __________________________________________________________________________
Signature:__________________________________________
Date:________________________________________

This form is to be filled by a Military Officer not below the rank of Lt Col or equivalent/Police Officer 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.
 Application Form
FOR OFFICIAL USE ONLY

Application Number: NNR37/2024/KAT/1361/0028023

Applicant's Full Name: MUSA AHMAD
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:_____________________________________________________