| 1.0 PERSONAL DETAILS |
| NIQS MEMBERSHIP NUMBER: | P00306U | | SURNAME: | UDOUSOROH | | OTHER NAMES: | LILY EFFIONG | | TITLE/GENDER: | MISS/FEMALE | | DATE OF BIRTH: | 2000-09-08 | | CHAPTER: | AKWA IBOM | | PHONE NUMBER: | 09054673789, | | EMAIL ADDRESS: | lilgolden9@gmail.com | | POSTAL ADDRESS: | 104 IKOT EKPENE ROAD, UYO, AKWA IBOM | | CURRENT MEMBERSHIP GRADE: | PROBATIONER | | DATE OF REGISTRATION: | 2023-08-08 | | 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 | C5 | | MATHEMATICS | C6 | | PHYSICS | C5 | | GEOGRAPHY | C4 | | BIOLOGY | C5 |
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| 4.0 EDUCATION: |
| SN | UNIVERSITY/INSTITUTION | COUNTRY | DEGREE/DIPLOMA NAME
(eg. B.Tech Quantity Surveying) | DATE COMPLETED | | 1 | HERITAGE POLYTECHNIC, EKET, AKWA IBOM STATE. | NIGERIA | HND IN QUANTITY SURVEYING | 2021-01-20 | | 2 | HERITAGE POLYTECHNIC, EKET, AKWA IBOM STATE. | NIGERIA | ND IN QUANTITY SURVEYING | 2018-08-27 |
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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 | TPC2/2025/01/64 | ABUJA | | LOGBOOK/DIARY STAGE 3 | FEBRUARY 2026 | | |
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| 7.0 PROFESSIONAL EXPERIENCE: |
| SN | EMPLOYER'S NAME AND ADDRESS | POSITION HELD & DATES | DUTIES | | 1 | GREYBOULDERS LIMITED, C5, 20TH STREET, GAMES VILLAGE, KAURA, F. C. T. | QUANTITY SURVEYOR (2026-02-02 - Date) | PREPARATION OF BILL OF QUANTITIES FOR BUILDING WORKS AND MEP WORKS. PREPARATION OF MATERIALS AND LABOUR SCHEDULE FOR MEP WORKS AND BUILDING WORKS. SITE VISIT FOR PROJECT SUPERVISION AND PROGRESS EVALUATION. | | 2 | SAMMYA NIGERIA LIMITED, MAITAMA, ABUJA. | ASSISTANT QUANTITY SURVEYOR (2023-03-06 - 2026-01-30) | PREPARATION OF BILL OF QUANTITIES FOR BUILDING, MEP INFRASTRUCTURAL WORKS AND CIVIL ENGINEERING WORKS. PREPARATION OF BUDGET FOR CONSTRUCTION WORKS. PREPARATION OF MATERIALS AND LABOUR SCHEDULE FOR MEP INFRASTRUCTURAL WORKS AND BUILDING WORKS VALUATION OF VARIATIONS. INTERIM VALUATION FOR PAYMENTS. PROJECT SUPERVISION | | 3 | DIRECTORATE OF PHYSICAL PLANNING, UNIVERSITY OF UYO, UYO, AKWA IBOM STATE | QUANTITY SURVEYING INTERN (2019-08-05 - 2019-10-25) | TAKING OF QUANTITIES FOR BUILDING WORKS. PREPARATION OF BOQ FOR BUILDING WORKS. SITE SUPERVISION. |
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| 8.0 EMPLOYER DETAILS |
| a) NAME OF EMPLOYER: | GREYBOULDERS LIMITED. | | b) EMPLOYER'S BUSINESS ADDRESS: | C5, 20TH STREET, GAMES VILLAGE, KAURA, F. C. T. | | c) NATURE OF EMPLOYER'S BUSINESS: | CONSTRUCTION COMPANY | | d) POSITION OF APPLICANT: | QUANTITY SURVEYOR | | e) DATE OF EMPLOYMENT: | 2026-02-02 |
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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: | 02938 | | b) SPONSOR'S FULL NAME: | EKUNG SAMUEL BASSEY | | c) SPONSOR'S EMAIL ADDRESS: | SAMBASSEY76@YAHOO.COM | | d) SPONSOR'S CONTACT ADDRESS: | 13 UDOBIO STREET UYO AKWA IBOM STATE | | e) SPONSOR'S MEMBERSHIP GRADE: | MEMBER | | f) SPONSOR'S RESGISTRATION DATE:: | 2010-05-05 |
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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: | AKWA IBOM
| | NAME: |
| | NIQS MEMBERSHIP NUMBER: |
| | DESIGNATION: |
| | PHONE NUMBER: |
| | DATE: |
| | EMAIL: |
| | SIGNATURE: |
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