SURVEYORS COUNCIL
OF NIGERIA (SURCON)
APPLICATION FOR
ENROLMENT/REGISTRATION
FORM
FOUR RECENT
PASSPORT
PHOTOGRAPHS OF
THE APPLICANT
A. PERSONAL DATA (IN BLOCK LETTERS)
(i)
(ii) Other Names
(iii) Gender: Male Female (Tick as Appropriate)
(iv) Place and Date of Birth
(v) (vi) Maiden Name (Married Women)
(vii) State of Origin: (viii) Nationality:
(ix) Ofce Address:
Phone No:
(x)
(xi) E-mail Address:
B. EDUCATIONAL QUALIFICATIONS
Year of Study Qualication
Name & Address of School(s) Year Obtained
Obtained
Applicant must have acquired the minimun O/L qualication before applying
Year of Study Qualication
Name & Address of School(s) Year Obtained
Obtained
Applicant must present certicate after three (3) years of graduation
Date Obtained
D. PROFESSIONAL EXPERIENCE (compulsory for those applying for G (i) and (ii) below)
G. TYPE OF REGISTRATION/ENROLMENT REQUIRED (Tick as Appropriate)
i. Surveyor
ii. Pupil Surveyor
iii. Technologist
iv. Technician
H. HAVE YOU BEEN CONVICTED OF ANY CRIMINAL OFFENCE?
If Yes give details:
I. PERSONAL DECLARATION BY THE APPLICANT:
of
CAP S18 LFN. 2004
(i) I have attained the age of 21
(ii) I have not been convicted of any criminal offence
(iii) I will pay the prescribed fees;
(iv) I will promote the good image, aims and objectives of the Survey profession;
(v) The information given by me on this application is correct to the best of my knowledge and belief
J. CERTIFICATION OF SUPERVISOR (who must be a Surveyor with a minimum of 5 years’
post-registration practice experience)
me and
my company/ofce since
Phone No:
K Email:
Please provide the following:
(i) Evidence of age
(ii) Evidence of Academic/Professional qualication
(iii) Evidence of payment for application form
(iv) Written Endorsement from Supervisor with SURCON Seal
a. Company Enlistment certicate where applicable
b. Supervisor’s current practice fee
c. Current payment for Company renewal
RRR Code:
