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Basic details

*First name:

Other names:

*Last name:

*Gender:

*Birthday:

*Phone No:

*Email:

ECZ#:

International student?

No:

Yes:

*NRC:

*Do you have a disability?:

*Marital status:

*Staff Child/Spouse:

*Secondary School:

*Nationality:

*Province:

*Town:

*Centre:

*Residential address:

*Postal address:

Next of kin names:

Kin phone No:

O-Level Results

Subject

Grade

X

X

X

X

X