| 1.0 PERSONAL DETAILS |
| NIQS MEMBERSHIP NUMBER: | P00104L | | SURNAME: | LELEGHIDIWEI | | OTHER NAMES: | CLIFFORD TARI | | TITLE/GENDER: | MR /MALE | | DATE OF BIRTH: | 1983-07-20 | | CHAPTER: | BAYELSA | | PHONE NUMBER: | 07038793674, | | EMAIL ADDRESS: | taricliff3674@gmail.com | | POSTAL ADDRESS: | MIN. OF LANDS, HOUSING & URBAN DEV. BAYELSA STATE PROJECT DEPT. ROOM 23 EDEPIE SCH. ROAD, YENAGOA | | CURRENT MEMBERSHIP GRADE: | PROBATIONER | | DATE OF REGISTRATION: | 2022-02-21 | | DIET: | MARCH, 2026 | | DISABILITY: | NO |
|
| |
| 2.0 PREFERRED INTERVIEW CENTRE: |
| ABUJA |
| |
| 3.0 O' LEVEL SUBJECTS RESULT (5 CREDITS FROM WAEC/NECO/NABTEB): |
| SUBJECTS | GRADE | | ENGLISH | B3 | | MATHEMATICS | B3 | | PHYSICS | C4 | | FURTHER MATHEMATICS | B3 | | ECONOMICS | C5 |
|
| |
| 4.0 EDUCATION: |
| SN | UNIVERSITY/INSTITUTION | COUNTRY | DEGREE/DIPLOMA NAME
(eg. B.Tech Quantity Surveying) | DATE COMPLETED | | 1 | RIVERS STATE UNIVERSITY | NIGERIA | B TECH IN QUANTITY SURVEYING | 2008-11-20 |
|
| |
| 5.0 MEMBERSHIP OF ANY OTHER PROFESSIONAL INSTITUTION(S): (IF ANY) |
| SN | NAME OF INSTITUTION | CURRENT GRADE | HOW MEMBERSHIP WAS ACHIEVED
(E.G. EXAMINATION) | YEAR REGISTERED/
OBTAINED/ELECTED |
|
| |
| 6.0 PATICULARS OF TPC EXAMINATION AND LOGBOOK/DIARY STAGE 3 PASSED (OR RICS MEMBERSHIP) |
| DETAILS | YEAR/MONTH | EXAM. NO.
(WHERE APPLICABLE) | CENTER
(WHERE APPLICABLE) | | TPC EXAMINATION | SEPTEMBER 2025 | TPC2/2025/03/144 | PORTHARCOURT RIVERS STATE UNIVERSITY | | LOGBOOK/DIARY STAGE 3 | JULY 2025 | | |
|
| |
| 7.0 PROFESSIONAL EXPERIENCE: |
| SN | EMPLOYER'S NAME AND ADDRESS | POSITION HELD & DATES | DUTIES | | 1 | BAYELSA STATE GOVERNMENT MINISTRY OF LANDS AND SURVEY | PRINCIPAL QUANTITY SURVEYOR (2006-02-15 - Date) | PREPARATION OF BOQS , VALUATION OF CLAIMS, PAYMENT OF INTERIM CERTIFICATE, TRAINING FOR JUNIOR STAFFS AND CORPS MEMBERS |
|
| |
| 8.0 EMPLOYER DETAILS |
| a) NAME OF EMPLOYER: | BAYELSA STATE GOVERNMENT MINISTRY OF LANDS AND SURVEY | | b) EMPLOYER'S BUSINESS ADDRESS: | MINISTRY OF LANDS AND SURVEY MAIN SECRETARIAT YENAGOA BAYELSA STATE | | c) NATURE OF EMPLOYER'S BUSINESS: | CONSTRUCTION | | d) POSITION OF APPLICANT: | PRINCIPAL QUANTITY SURVEYOR | | e) DATE OF EMPLOYMENT: | 2006-02-15 |
|
| |
| f) I hereby attest that to the best of my knowledge, the particulars given by me and the applicant here are true and correct. |
| |
EMPLOYER'S SIGNATURE & DATE |
| |
| 9.0 SPONSOR DETAILS |
| a) SPONSOR'S NIQS MEMBERSHIP NUMBER: | 02004 | | b) SPONSOR'S FULL NAME: | AMANGALA MABEL MORRIS | | c) SPONSOR'S EMAIL ADDRESS: | MABELAOZI@GMAIL.COM | | d) SPONSOR'S CONTACT ADDRESS: | MININSTRY OF WORKS AND TRANS DEPT OF Q S AND BUILDING SERV P M B 46, YENAGOA BAYELSA | | e) SPONSOR'S MEMBERSHIP GRADE: | FELLOW | | f) SPONSOR'S RESGISTRATION DATE:: | 2024-11-26 |
|
| |
| g) I hereby declare that to the best of my knowledge, the particulars given by me and the applicant here are true and correct. |
| |
SPONSOR'S SIGNATURE & DATE |
| |
| 10.0 APPLICANT'S DECLARATION |
I declare that the particulars given on this form are true and correct and that I will abide by the Rules and Regulations governing the Institute’s Examinations.
By completing and submitting this application form, you agree to be bound by all existing NIQS Examination Policies, Rules and Guidelines and the rules guiding the MARCH, 2026 professional examination in particular.
|
| Applicant's Signature.......................................................................... Date.............................................. |
| |
| 11.0 STATE CHAPTER CHAIRMAN/SECRETARY (COMPULSORY) TO BE COMPLETED MANUALLY |
| CHAPTER: | BAYELSA
| | NAME: |
| | NIQS MEMBERSHIP NUMBER: |
| | DESIGNATION: |
| | PHONE NUMBER: |
| | DATE: |
| | EMAIL: |
| | SIGNATURE: |
|
|
|
PC12