DOMINICAN UNIVERSITY IBADAN
Educational Layout, Samonda, Ibadan
www.dui.edu.ng; info@dui.edu.ng
P.M.B 5361, Ibadan, Oyo State
STUDENTS' REFERRAL CLAIM FORM
Submitted on: January 1, 1970, 12:00 am
Reference Number: REF-000000
| Details of the Referrer | |
|---|---|
| Name | |
| Department/Unit/Institution | |
| Status | |
| Phone Number | |
| Email Address | |
| Account Number | |
| Bank Name | |
| Details of Referred Candidate | |
|---|---|
| Name | |
| Programme of Choice | |
| UTME Reg No | |
| UTME Score | |
| Email Address | |
| Phone number | |
| Phone number of Parents/Guardians | |
Mode(s) of interaction with the candidate/parent/guardian:
| Account Details | |
|---|---|
| Account Name | |
| Account Number | |
| Bank Name | |
Attestation
I hereby declare that the pieces of information supplied above are true and verifiable. I have also read, and therefore, accepted the attached terms and conditions associated with the scheme.
Declaration Accepted: YES
Date: January 1, 1970