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 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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