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Ministry/Department/Agency (MDA):*
National Identification Number (NIN):*
e.g. F5432684
Note:By inputting the Mandatory (NiN), I hereby affirm that the National Identification Number (NIN) is correct and has been issued to me, I am aware that should I declare or register using another person (NiN) or an invalid (NIN), I shall be liable to penalties..

Personal Details:

ADF No:*
e.g. A001/000001/16
First Name:*
Middle Name:
Previous Name/Aliases:
Confirm Password:*
Date of Birth:* Day: Month: Year:
Present Citizenship:*
Details of any other Citizenship:
Marital Status:* Married Single Divorced
Separated Widowed
Gender:* Male Female

Employment Details:

Employee Category:*.
Current Posting:
Rank / Grade:
Employee Pin No (if any):
Establishment Registration Number (if any):
Source of Income:
(e.g. Employment, Rent, Farm land, Business Interest etc, and Others, please specify.....)
Do you have an administrative responsibility:* Yes No
Do you have financial responsibility:* Yes No
Do you have political responsibility:* Yes No
Do you have a professional responsibility:* Yes No

Contact Details:

Confirm Email:*
Permanent (Mailing) Address:*
District and Province:*
Present Address:
Same as above
District and Province:
Passport Number(s) (if any):
National ID Card Number (if any):

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