Record Entry

Bio-Data

H/C No:

NHIS NO:

Title:

Surname:

Other Names:

Gender:

Tribe:

Age:

Faculty:

State of Origin:

Home Town:

Your Picture

Home Address:

Marital Status:

Staff ID:

Department:

Occupation:

Phone Number:

Date of Birth:

Nationality:

Religion:

Blood Group:

Genotype:

Allergy:

Next of Kin

Name:

Relationship:

Address:

Contact Number: