4/6/25, 9:40 PM 89RRI-PL-9021890
This document was last modified on 2025-04-06 21:37:25.298567
PHOTO CARD
Surname WALSHAK
First Name SAMUEL
Other Name(s) AMOS
Regular Intake 89RRI
Application Number 89RRI-PL-9021890
Date Of Birth 2003-10-05
State Of Origin Plateau
LGA Mangu
Type Of O'Level
NOK Name LONGKAT AMOS
NOK Phone Number 09037766824
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4/6/25, 9:40 PM 89RRI-PL-9021890
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ARMY HEADQUARTERS
DEPARTMENT OF ARMY ADMINISTRATION
Application Number 89RRI-PL-9021890
Full Name WALSHAK SAMUEL AMOS
State of Origin Plateau
Address CHICHIM MANGU LGA
DECLARATION BY APPLICANT
I (above named) hereby declare that the information given in this application is true and if found to be false I shall be prosecuted.
Sign _____________________________________ Date _______________________
DECLARATION BY PARENT/GUARDIAN OF APPLICANT
(To be made at a recognised court of law)
I ______________________________ parent/guardian of SAMUEL WALSHAK who is applying for the recruitment into the
Nigerian Army, hereby certify that I fully understand that my child/ward will (if required to) attend the Recruitment Exercise and I
shall not demand compensation or relief from the Governemnt in respect for death or injury which my child/ward may sustain in
the course of or as a result of any task given to him during the exercise.
Parent/Guardian Sign _____________________________________ Date ____________________
Parent/Guardian Witnesses
Before Me ________________________________________
Name and Signature of witness
Address _____________________________________
Date ________________________________________
Before Me ________________________________________
Name and Signature of witness
Address _____________________________________
Date ________________________________________
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4/6/25, 9:40 PM 89RRI-PL-9021890
This document was last modified on 2025-04-06 21:37:25.298567
ARMY HEADQUARTERS
DEPARTMENT OF ARMY ADMINISTRATION
Application Number 89RRI-PL-9021890
Full Name WALSHAK SAMUEL AMOS
State of Origin Plateau
Address CHICHIM MANGU LGA
CERTIFICATION BY LOCAL GOVERNMENT CHAIRMAN/SECRETARY
I certify that the applicant _______________________________ is an indigene of _______________ LGA ___________ State.
To the best of my knowledge and belief the facts stated on the form are correct.
Name: _______________________________________
Address: _____________________________________
_____________________________________________
_____________________________________________
Signature (Council Stamp):______________________
Date: ________________________________________
CERTIFICATION BY DPO
I certify that the applicant ___________________________ is an indigene of ________________ LGA _________ State and
that his/her parent hails from _________ LGA _________ State. That he/she has no criminal record (If any state below).
.
This is to the best of my knowledge and belief the facts stated in the form are correct and I hereby declare that if any statement
made in connection with htis application is preven false. I shall be prosecuted.
Name of Referee: ____________________________________________________________________
Contact Address: ____________________________________________________________________
Email: ______________________________________________________________________________
Phone: ______________________________________________________________________________
Signature: __________________________________________________________________________
Date: _______________________________________________________________________________
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ARMY HEADQUARTERS
DEPARTMENT OF ARMY ADMINISTRATION
GUARANTOR'S FORM
(Any false information provided on an applicant could attract criminal prosecution in a court of law)
To be completed by A Military Officer not below the rank of Major or equivalent Police Officer not below the rank of Chief
Superintendent of Police/Assistant Director of either Federal or State Civil Service certifying the eligibility of the applicant. You
need not to come from the applicant's State of Origin to guarntee him/her only be sure of the character. Please note that inability
to confirm the below given information about you will lead to automatic disqualification of the candidate.
Application Number 89RRI-PL-9021890
Full Name WALSHAK SAMUEL AMOS
Date of Birth/ Gender 2003-10-05/Male
State of Origin (LGA) Plateau(Mangu)
PARTICULARS OF GUARANTOR
PASSPORT
PHOTOGRAPH
First Name: _________________________________________________________________________
Surname: ____________________________________________________________________________
Other names: ________________________________________________________________________
Contact Address: ____________________________________________________________________
Email: ______________________________________________________________________________
Phone: ______________________________________________________________________________
State of Origin: ____________________________________________________________________
LGA: ________________________________________________________________________________
Town: _______________________________________________________________________________
Formation/Unit: _____________________________________________________________________
Rank/Appointment: ___________________________________________________________________
How long have your known the applicant ?: ___________________________________________
Signature: __________________________________________________________________________
Date/Stamp: _________________________________________________________________________
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