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Surname:     Other Names:  
Address:      
Telephone:     Email:  
                .      
             
Exam No.    
Exam Centre    
Agents's Name:    
Is his name on our website as an accredited agent: Yes No
       
Subjects written in the exams:
(Ordinary Level)   (Advanced Level)
 
SUBJECT 1     SUBJECT 1  
SUBJECT 2     SUBJECT 2  
SUBJECT 3     SUBJECT 3  
SUBJECT 4              
SUBJECT 5              
SUBJECT 6              
                 
What are your complaints. (Please be brief)?
       
                 
Did you pay cash to the Agent? Yes No
                 
Did you pay to our bank account? Yes No
If yes state Teller No.,Date of payment, Bank Name and Account Number
           
             
               
                 

Note:
You can also copy this form out if you dont want to fill online and attach all necessary documents and post to

IJMB, P. O. Box 6951 Shomolu, Lagos or IJMB, P.O. Box 606 Garki, Abuja

You may also text the information to 0805-955-5559

                 
 

 

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