| 1.0 PERSONAL DETAILS |
| NIQS MEMBERSHIP NUMBER: | P00354E | | SURNAME: | EDEKE | | OTHER NAMES: | OKPOH ETIM | | TITLE/GENDER: | MR/MALE | | DATE OF BIRTH: | 1986-05-19 | | CHAPTER: | LAGOS | | PHONE NUMBER: | 08039231237, | | EMAIL ADDRESS: | henshaw002@gmail.com | | POSTAL ADDRESS: | 65, ALLEN AVENUE, IKEJA | | CURRENT MEMBERSHIP GRADE: | PROBATIONER | | DATE OF REGISTRATION: | 2022-10-07 | | 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 | A2 | | PHYSICS | C6 | | BIOLOGY | C6 | | CHEMISTRY | E8 |
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| 4.0 EDUCATION: |
| SN | UNIVERSITY/INSTITUTION | COUNTRY | DEGREE/DIPLOMA NAME
(eg. B.Tech Quantity Surveying) | DATE COMPLETED | | 1 | ENUGU STATEUNIVERSITY OF SCIENCE AND TECHNOLOGY | NIGERIA | BSC IN QUANTITY SURVEYING | 2013-11-10 |
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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 | JULY 2025 | 151 | LAGOS STATE | | 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 | OLOWOLE GBENGA | PRINCIPAL DIRCTOR (2025-11-09 - Date) | PROJECT MANAGER |
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| 8.0 EMPLOYER DETAILS |
| a) NAME OF EMPLOYER: | OLOWOLE GBENGA | | b) EMPLOYER'S BUSINESS ADDRESS: | 39 IKOYI ROAD | | c) NATURE OF EMPLOYER'S BUSINESS: | PURELY ON PROJECT MANAGEMENT | | d) POSITION OF APPLICANT: | PRINCIPAL DIRCTOR | | e) DATE OF EMPLOYMENT: | 2012-11-11 |
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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: | 02568 | | b) SPONSOR'S FULL NAME: | DADA SAMUEL OLUWATOBA | | c) SPONSOR'S EMAIL ADDRESS: | DADASAMUEL2000@YAHOO.COM | | d) SPONSOR'S CONTACT ADDRESS: | P. O. BOX 4849 MARINA, LAGOS | | e) SPONSOR'S MEMBERSHIP GRADE: | MEMBER | | f) SPONSOR'S RESGISTRATION DATE:: | 2008-09-04 |
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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: | LAGOS
| | NAME: |
| | NIQS MEMBERSHIP NUMBER: |
| | DESIGNATION: |
| | PHONE NUMBER: |
| | DATE: |
| | EMAIL: |
| | SIGNATURE: |
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PC73