| 1.0 PERSONAL DETAILS |
| NIQS MEMBERSHIP NUMBER: | P02038A | | SURNAME: | AGBAI | | OTHER NAMES: | GODWIN EBIMBOWEI | | TITLE/GENDER: | MR/MALE | | DATE OF BIRTH: | 1984-07-03 | | CHAPTER: | BAYELSA | | PHONE NUMBER: | 07030682100, | | EMAIL ADDRESS: | agbaiebimbowei@gmail.com | | POSTAL ADDRESS: | MIN. OF LANDS, HOUSING AND URBAN DEV. P.M.B. 16, YENAGOA | | CURRENT MEMBERSHIP GRADE: | PROBATIONER | | DATE OF REGISTRATION: | 2022-02-21 | | DIET: | MARCH, 2026 | | DISABILITY: | NO |
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| 2.0 PREFERRED INTERVIEW CENTRE: |
| ABUJA |
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| 3.0 O' LEVEL SUBJECTS RESULT (5 CREDITS FROM WAEC/NECO/NABTEB): |
| SUBJECTS | GRADE | | ENGLISH | C4 | | MATHEMATICS | C5 | | PHYSICS | C5 | | ECONOMICS | B3 | | GEOGRAPHY | C6 |
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| 4.0 EDUCATION: |
| SN | UNIVERSITY/INSTITUTION | COUNTRY | DEGREE/DIPLOMA NAME (eg. B.Tech Quantity Surveying) | DATE COMPLETED | | 1 | FEDERAL UNIVERSITY OF TECHNOLOGY MINNA | NIGERIA | B.TECH IN QUANTITY SURVEYING | 2012-02-24 |
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| 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 |
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| 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 | TPC2/2025/03/134 | PORTHARCOURT | | LOGBOOK/DIARY STAGE 3 | JULY 2025 | | |
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| 7.0 PROFESSIONAL EXPERIENCE: |
| SN | EMPLOYER'S NAME AND ADDRESS | POSITION HELD & DATES | DUTIES | | 1 | BAYELSA STATE GOVERNMENT, MINISTRY OF LANDS AND SURVEY, PROJECT DEPARTMENT SECRETARIAT COMPLEX | SENIOR QUANTITY SURVEYOR (2019-07-01 - Date) | PREPARATION OF BOQ, INTERIM PAYMENT CERTIFICATE, VALUATION, SITE SUPPERVISION | | 2 | BAYELSA STATE GOVERNMENT, MINISTRY OF LANDS AND SURVEY, PROJECT DEPARTMENT SECRETARIAT COMPLEX | SENIOR QUANTITY SURVEYOR 1( CASUAL STAFF ) (2016-11-01 - 2019-07-01) | PREPARATION OF BOQ, SITE SUPPERVISION | | 3 | OYINTEKE GLOBAL LTD | SITE QUANTITY SURVEYOR (2014-12-04 - 2015-08-07) | PREPARATION OF MATERIAL SCHEDULE VALUATION, SITE SUPPERVISION | | 4 | CITY CENTRAL GROUP OF COMPANIES | NYSC CORP MEMBER (2012-03-06 - 2013-03-05) | PREPARATION OF BOQ, SITE SUPPERVISION |
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| 8.0 EMPLOYER DETAILS |
| a) NAME OF EMPLOYER: | BAYELSA STATE GOVERNMENT | | b) EMPLOYER'S BUSINESS ADDRESS: | BAYELSA STATE MINISTRY OF LANDS AND SURVEY PROJECT DEPARTMENT SECRETARIAT COMPLEX YENAGOA | | c) NATURE OF EMPLOYER'S BUSINESS: | CONSTRUCTION , DRAWING ,DESIGN AND PROJECT MANAGEMENT | | d) POSITION OF APPLICANT: | SENIOR QUANTITY SURVEYOR | | e) DATE OF EMPLOYMENT: | 2019-07-01 |
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| f) I hereby attest that to the best of my knowledge, the particulars given by me and the applicant here are true and correct. |
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 EMPLOYER'S SIGNATURE & DATE |
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| 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 |
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| g) I hereby declare that to the best of my knowledge, the particulars given by me and the applicant here are true and correct. |
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 SPONSOR'S SIGNATURE & DATE |
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| 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.
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| Applicant's Signature.......................................................................... Date.............................................. |
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| 11.0 STATE CHAPTER CHAIRMAN/SECRETARY (COMPULSORY) TO BE COMPLETED MANUALLY |
| CHAPTER: | BAYELSA | | NAME: |
| | NIQS MEMBERSHIP NUMBER: |
| | DESIGNATION: |
| | PHONE NUMBER: |
| | DATE: |
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| | SIGNATURE: |
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