PBIC | Student Registration Form

Student Information
Full Name

SurnameFirst NameMiddle Name
Gender
Nationality
Birth Date

MonthDayYear
Village/Home Town
LGA/State of Origin
Address

Postal Address

Residential Address

CityState / Province
Phone Number

Country CodeArea CodePhone Number
Religion
Denomination
Last School of Attendance
Last Class of Attendance
Date of Last Attendance

MonthDayYear
Date
Result of Your Last Term Exam
Intended Class of Entry
Which class do you want to be admitted into.
Upload Passport

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Why do you want to be admitted into this College?
Answer in 1 or 2 sentences only

Parent's/Guardian's Data
Father's Name

SurnameFirst NameMiddle Name
Alive/Deceased
Mother's Name

SurnameFirst NameMiddle Name
Alive/Deceased
Guardian's Name

SurnameFirst NameMiddle Name
Alive/Deceased
Contact Address
Phone Number

Country CodeArea CodePhone Number
Email
example@example.com
Religion
Denomination
Occupation
Working/Retired
Dear parent/guardian, how will you be able to finance the schooling of your child/ward in this College?
Answer within two lines only
Do you declare that the information provided above are true and correct?
Please verify that you are human*
Admission Form Fee

Pay #7,000 to 1026330993(Bank: UBA) Acct Name: Precious Blood International College Logistics. (Ensure to SEND PROOF of payment to the Bursary for confirmation).
Should be Empty:

Admission Form Fee