| 1.0 PERSONAL DETAILS |
| NIQS MEMBERSHIP NUMBER: | P02292A | | SURNAME: | ALIEGBA | | OTHER NAMES: | JEMIMA YESI | | TITLE/GENDER: | MISS /F | | DATE OF BIRTH: | 1996-12-21 | | CHAPTER: | ABUJA | | PHONE NUMBER: | 08107073459, | | EMAIL ADDRESS: | jemima1477@gmail.com | | POSTAL ADDRESS: | HOUSE NO 6 UNITY ESTATE, KARU ESTATE, ABUJA | | CURRENT MEMBERSHIP GRADE: | PROBATIONER | | DATE OF REGISTRATION: | 2024-01-18 | | DIET: | MARCH, 2026 | | DISABILITY: | |
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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 | - | | MATHEMATICS | - | | PHYSICS | - |
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| 4.0 EDUCATION: |
| SN | UNIVERSITY/INSTITUTION | COUNTRY | DEGREE/DIPLOMA NAME
(eg. B.Tech Quantity Surveying) | DATE COMPLETED |
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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 | | | | | LOGBOOK/DIARY STAGE 3 | | | |
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| 7.0 PROFESSIONAL EXPERIENCE: |
| SN | EMPLOYER'S NAME AND ADDRESS | POSITION HELD & DATES | DUTIES |
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| 8.0 EMPLOYER DETAILS |
| a) NAME OF EMPLOYER: | | | b) EMPLOYER'S BUSINESS ADDRESS: | | | c) NATURE OF EMPLOYER'S BUSINESS: | | | d) POSITION OF APPLICANT: | | | e) DATE OF EMPLOYMENT: | |
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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: | | | b) SPONSOR'S FULL NAME: | | | c) SPONSOR'S EMAIL ADDRESS: | | | d) SPONSOR'S CONTACT ADDRESS: | | | e) SPONSOR'S MEMBERSHIP GRADE: | | | f) SPONSOR'S RESGISTRATION DATE:: | |
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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: | ABUJA
| | NAME: |
| | NIQS MEMBERSHIP NUMBER: |
| | DESIGNATION: |
| | PHONE NUMBER: |
| | DATE: |
| | EMAIL: |
| | SIGNATURE: |
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