| 1.0 PERSONAL DETAILS |
| NIQS MEMBERSHIP NUMBER: | P00380E | | SURNAME: | EKPO | | OTHER NAMES: | IKWO EMMANUEL | | TITLE/GENDER: | MRS /FEMALE | | DATE OF BIRTH: | 1977-09-09 | | CHAPTER: | CROSS RIVER | | PHONE NUMBER: | 08138847447, | | EMAIL ADDRESS: | EFFIOMIKWO267@GMAIL.COM | | POSTAL ADDRESS: | NO 28 HART STREET, CALABAR | | CURRENT MEMBERSHIP GRADE: | PROBATIONER | | DATE OF REGISTRATION: | 2024-02-22 | | 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 | C6 | | MATHEMATICS | B3 | | PHYSICS | C6 | | CHEMISTRY | C5 | | CHEMISTRY | A1 |
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| 4.0 EDUCATION: |
| SN | UNIVERSITY/INSTITUTION | COUNTRY | DEGREE/DIPLOMA NAME
(eg. B.Tech Quantity Surveying) | DATE COMPLETED | | 1 | AKANU IBIAM FEDERAL POLYTECHNIC | NIGERIA | HND IN QUANTITY SURVEYING | 2017-08-08 |
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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 | TPC2/2025/03/141 | PORT HARCOURT | | 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 | STATE UNIVERSAL BASIC EDUCATION BROAD | CHIEF TECHNICAL OFFICER (2021-01-12 - Date) | PREPARE BILLS OF QUANTITY, INSPECT PROJECT |
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| 8.0 EMPLOYER DETAILS |
| a) NAME OF EMPLOYER: | STATE UNIVERSAL BASIC EDUCATION BROAD | | b) EMPLOYER'S BUSINESS ADDRESS: | 120 MUTALA MUHAMMAD HIGH WAY, CALABAR,CROSS RIVER STATE | | c) NATURE OF EMPLOYER'S BUSINESS: | CIVIL SERVANTS | | d) POSITION OF APPLICANT: | CHIFE TECHNICAL OFFICER | | e) DATE OF EMPLOYMENT: | 2001-04-02 |
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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: | 04326 | | b) SPONSOR'S FULL NAME: | OWOEYE VICTOR OLADIMEJI | | c) SPONSOR'S EMAIL ADDRESS: | VICK4INFLUENCE@YAHOO.COM | | d) SPONSOR'S CONTACT ADDRESS: | P.M.B 1115, CALABAR, UNIVERSITY OF CALABAR, OFFICE OF DIRECTOR OF PHYSICAL PLANNING | | e) SPONSOR'S MEMBERSHIP GRADE: | MEMBER | | f) SPONSOR'S RESGISTRATION DATE:: | 2018-09-19 |
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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: | CROSS RIVER
| | NAME: |
| | NIQS MEMBERSHIP NUMBER: |
| | DESIGNATION: |
| | PHONE NUMBER: |
| | DATE: |
| | EMAIL: |
| | SIGNATURE: |
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