JOINT ADMISSIONS AND MATRICULATION BOARD

National Headquarters, Suleja-Bwari Road, Bwari, P. M. B. 189, Garki Abuja, Nigeria.

Condonement of Illegitimate Admission (without Registration Number) Application
2016 Unified Tertiary Matriculation Examination (UTME)
(Completion of this form does not guarantee Approval) Reg. (ITS) No.: 007
Date Printed: Tuesday, May 21, 2024

REFERENCE NO.: 2024151466861514

CANDIDATE PERSONAL DETAILS
NAMES: Waya, Ebi
DATE OF BIRTH: May 23, 1988
GENDER: Female MARITAL STATUS: S
ORIGIN: Yenegoa in Bayelsa
EMAIL ADDRESS: wayaebi17@gmail.com GSMNo: 09128887168
ADDRESS: Opp. Prison Yard Okaka Yenagoa Bayelsa State
APPLICATION DATA FOR PREVIOUSLY ILLEGITIMATE ADMISSION O'LEVEL SUBJECTS AND GRADES
REGISTRATION NUMBER: 7768595842 Bible Knowled/CRK (Grade:B3)
YEAR OF ENROLMENT: 2016 Economics (Grade:C6)
Candidate's Institution Details Government (Grade:B3)
INSTITUTION ENROLLED History (Grade:B3)
OND English Lang. (Grade:C6)
Delta State Polytechnic, Ozoro Mathematics (Grade:C6)
Fisheries Technology Agricultural Science (Grade:C5)
REASON FOR NOT BEING ON JAMB LIST: I did not take JAMB Form Biology (Grade:C4)
MATRICULATION NUMBER: DSPZ/SOA/17/07124 Chemistry (Grade:B3)
MATRICULATION YEAR: 2016
Must be Printed with Colour Printer

SERIAL NO. ON GRADUATING LIST: Candidate Serial No On Graduatin List

HEAD OF INSTITUTION: Dr. Jameslove Kperegbeyi
REGISTRAR: Mrs. Oshiegbu Margret
YEAR OF GRADUATION: 2022

UTME Details FIRST CHOICE

UTME SCORE: 0 OND
Delta State Polytechnic, Ozoro
UTME SUBJECTS Fisheries Technology
Use of English
Agriculture SECOND CHOICE
Biology OND
Chemistry Delta State Polytechnic, Ozoro
Fisheries Technology
................................................................
Candidate's Signature/Date

INDEMNITY: To be given (Completed) by the Head of Institution

I confirm the facts above and hereby indemnify JAMB against any inaccuracy of the claims. I also note that I will be personally
liable for any false information contained herein
I affirm that if JAMB approves the Condonement of Illegitimate Admission (without Registration Number) Application, we will
correct our record accordingly.
Name of Head of Institution: Dr. Jameslove Kperegbeyi
...............................................................................
Head of Institution's Signature/Date/Stamp
OFFICE USE
Name of JAMB staff.......................................................................
Department/Unit............................................................................
Status of Request (Approved/Not Approved)......................................................
.............................................................................
Date/Sign
NOTE:
1. The candidate pays a penalty of N5000 in addittion to what he/she ought to have paid if he/she had processed legitimate application.
2. The indemnity form is auto generated to indemnify JAMB by the institution.
Registered At: (UTME2017/06040004) ::: JAMB State Office Yenagoa 3 Police Headquarter Road Ovom, Yenagoa, Bayelsa State
 JOINT ADMISSIONS AND MATRICULATION BOARD
National Headquarters, Suleja-Bwari Road, Bwari, P.M.B. 189, Garki Abuja, Nigeria.
Request for Condonment of Illegal Admission Application Form (For past years)
Unified Tertiary Matriculation Examination (UTME)
(Completion of this form does not guarantee Approval)

ACKNOWLEDGEMENT SLIP

REFERENCE NO.:

Normal Registration Data

NAMES:

DATE OF BIRTH:

GENDER:

MARITAL STATUS:

ORIGINAL:

EMAIL ADDRESS:

GSM NUMBER:

ADDRESS:

Date Indemnity Form was submitted to Institution Name of Institution

Name of Institution Officer who received the Indemnity Form Signature/Date

Candidate's Signature/Date of Submission

Note

1. Candidate should submit a copy of this Acknowledgement Slip to JAMB Office in the State where the Institution is located after the
Institution has received the Indemnity Form and endorsed this Slip.

2. The Candidate is required to keep a copy of this Acknowledgement Slip.

3. Acknowledgement Slip is for JAMB Office and Candidate only, NOT to be kept by the Institution.