Application Form

Application Number National Identification Number Bank Verification Number

NNR37/2024/BOR/7500/0151097 51520753442 22614314607

Category Exam State Exam Center

Seaman - D1 Borno ARMY CDSS MAIMALARI BARRACKS

Title Surname First Name

Mr KANO ABDULSALAM

Other Name Height Religion

GARBA 1.75 Islam

Marital Status Gender Date Of Birth

Single M Saturday, December 9, 2006

State of Origin LGA of Origin Mobile Number

Borno Maiduguri 08026696448

Home Town Permanent Address

MAIDUGURI HAUSARI BABBAN LAYI MAIDUGURI

Parent/ Guardian Detail

Full Name Contact Address

GARBA MOHAMMED HAUSARI BABBAN LAYI MAIDUGURI

Next Of Kin

Full Name Relationship Mobile Number

MOHAMMED GARBA Brother 08026696448

Occupation Contact Address

Business Man HAUSARI BABBAN LAYI MAIDUGURI
 Application Form
Referee Details

Referee Name Phone Referee Address

JAMILA GARBA KANO 08039420094 GOMARI KARSHEN KWALTA MAIDUGURI

HABIBA GARBA KANO 08109211700 DALA KWANAN OC MAIDUGURI

Primary Details
School Qualification From To

Kirikasamma Primary School fslc 2008 2013

Secondary Details

School Qualification From To

Kirikasamma Primary School neco 2013 2020

SSCE / NECO / WASSCE / GCE

Subject Grade Examination

Mathematics C6 CREDIT 20228906HB

English C6 CREDIT 20228906HB

Physics C5 CREDIT 20228906HB

Biology B3 GOOD 20228906HB

Agricultural Science C5 CREDIT 20228906HB

Civic Education C5 CREDIT 20228906HB

Islamic Studies C6 CREDIT 20228906HB

Tertiary Details

Institution Course of Study Type From To Grade

 Application Form
APPLICANT'S DECLARATION

Application Number
NNR37/2024/BOR/7500/0151097

Application Number: NNR37/2024/BOR/7500/0151097

I KANO ABDULSALAM, 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/BOR/7500/0151097

Title Surname First Name

Mr KANO ABDULSALAM

Other Name Height Religion

GARBA 1.75 Islam

Marital Status Gender Date Of Birth

Single M Saturday, December 9, 2006

State of Origin LGA of Origin Mobile Number

Borno Maiduguri 08026696448

Home Town Permanent Address

MAIDUGURI HAUSARI BABBAN LAYI MAIDUGURI

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/BOR/7500/0151097

Title Surname First Name

Mr KANO ABDULSALAM

Other Name Height Religion

GARBA 1.75 Islam

Marital Status Gender Date Of Birth

Single M Saturday, December 9, 2006

State of Origin LGA of Origin Mobile Number

Borno Maiduguri 08026696448

Home Town Permanent Address

MAIDUGURI HAUSARI BABBAN LAYI MAIDUGURI

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/BOR/7500/0151097

Title Surname First Name

Mr KANO ABDULSALAM

Other Name Height Religion

GARBA 1.75 Islam

Marital Status Gender Date Of Birth

Single M Saturday, December 9, 2006

State of Origin LGA of Origin Mobile Number

Borno Maiduguri 08026696448

Home Town Permanent Address

MAIDUGURI HAUSARI BABBAN LAYI MAIDUGURI

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 Offi cer not below the rank of Lt Col or equivalent/Police Offi cer 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/BOR/7500/0151097

Applicant's Full Name: KANO ABDULSALAM
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:_____________________________________________________