| 1.0 PERSONAL DETAILS |
| NIQS MEMBERSHIP NUMBER: | P00067C | | SURNAME: | CHUKWU | | OTHER NAMES: | TOCHUKWU | | TITLE/GENDER: | MR./MALE | | DATE OF BIRTH: | 1989-01-21 | | CHAPTER: | BAYELSA | | PHONE NUMBER: | 08028131694, | | EMAIL ADDRESS: | tochukwuchukwu01@gmail.com | | POSTAL ADDRESS: | 28 FLAT OLD ASSEMBLY QUARTERS YENAGOA, BAYELSA STATE | | CURRENT MEMBERSHIP GRADE: | PROBATIONER | | DATE OF REGISTRATION: | 2023-02-07 | | DIET: | MARCH, 2026 | | DISABILITY: | NO |
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| 2.0 PREFERRED INTERVIEW CENTRE: |
| LAGOS |
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| 3.0 O' LEVEL SUBJECTS RESULT (5 CREDITS FROM WAEC/NECO/NABTEB): |
| SUBJECTS | GRADE | | ENGLISH | C6 | | MATHEMATICS | B3 | | PHYSICS | B3 | | ECONOMICS | C6 | | GEOGRAPHY | B3 |
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| 4.0 EDUCATION: |
| SN | UNIVERSITY/INSTITUTION | COUNTRY | DEGREE/DIPLOMA NAME
(eg. B.Tech Quantity Surveying) | DATE COMPLETED | | 1 | IMO STATE UNIVERSITY, OWERRI, IMO STATE | NIGERIA | B.SC. IN QUANTITY SURVEYING | 2011-09-20 |
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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 | | 1 | NIGERIAN INSTITUTE OF QUANTITY SURVEYORS | PROBATIONER | REGISTRATION | 2023 |
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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 | TPC2/2025/03/140 | PORT-HARCOURT | | 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 | PRAXIS CONSTRUCTION COMPANY | PROJECT MANAGER (2015-12-15 - Date) | PROJECT COORDINATION, ESTIMATING, BUDGETING, CONSTRUCTION COST CONTROL AND PROJECT SUPERVISION. |
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| 8.0 EMPLOYER DETAILS |
| a) NAME OF EMPLOYER: | PRAXIS CONSTRUCTION COMPANY | | b) EMPLOYER'S BUSINESS ADDRESS: | 47 AIRFORCE ROAD, ISAAC BORO EXPRESSWAY, OKAKA YENAGOA, BAYELSA STATE | | c) NATURE OF EMPLOYER'S BUSINESS: | CONSTRUCTION | | d) POSITION OF APPLICANT: | PROJECT MANAGER | | e) DATE OF EMPLOYMENT: | 2015-12-15 |
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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: | 02005 | | b) SPONSOR'S FULL NAME: | AMUDA OGOCHUKWU ASAMA | | c) SPONSOR'S EMAIL ADDRESS: | AMUDAOGOCHUKWU2@GMAIL.COM | | d) SPONSOR'S CONTACT ADDRESS: | 1, UNEZ ERONINI STREET,IKENEGBU LAYOUTP O BOX 440, OWERRI | | e) SPONSOR'S MEMBERSHIP GRADE: | FELLOW | | f) SPONSOR'S RESGISTRATION DATE:: | 2025-11-13 |
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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
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| | NIQS MEMBERSHIP NUMBER: |
| | DESIGNATION: |
| | PHONE NUMBER: |
| | DATE: |
| | EMAIL: |
| | SIGNATURE: |
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