INFORMATION REQUIRED FOR THE APC E- REGISTRATION

1. NIN:
2. TITLE:
3. FIRST NAME:
4. MIDDLE NAME:
5. LAST NAME:
6. PHONE NUMBER:
7. ALTERNATIVE:
8. E-MAIL:
9. D O B:
10. GENDER:
11. MARITAL STATUS:
12. ADDRESS:
13. OCCUPATION:
14. RELIGION:
15. STATE:
16. LOCAL GOVT:
17. WARD
18. POLLING UNIT/ADDRESS:
19. INEC VOTER'S CARD VIN:


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