DELTA STATE BURSARY & SCHOLARSHIP BOARD

Anwai Road
P.M.B. 95103
Asaba

Application Form No.: 148158 /

Surname Other Names

ABEKE EJIRO FREGENE
Gender Marital Status State of Origin
Male single Delta
LGA Nationality Home Town Place of Birth Date of Birth
Sapele NIGERIAN SAPELE DELTA 03/11/1989
Present Address Permanent Address e-mail Address
20 OLORUNLOGBON STR ANTHONY
20 OLORUNLOGBON
VILLAGE LAGOSSTR
STATE
ANTHONY VILLAGE
FREGENEZONE_1145@YAHOO.COM
LAGOS STATE
Fathers Name Residential Address
ABEKE MATHEW FREGENE 20 OLORUNLOGBON STR ANTHONY VILLAGE LAGOS STATE
Office Address Contact Address
14 OLORUNLOGBON STR ANTHONY VILLAGE LAGOS
20 STATE
OLORUNLOGBON STR ANTHONY VILLAGE LAGOS STATE
Occupation LGA Home Town
TECHNICIAN Sapele SAPELE
Mothers Name Home Town
ABEKE TITE FREGENE SAPELE
Inst.Code Name of Institution Matric.No
24099 LAGOS STATE POLYTECHNIC 082052018
Level Degree in View GPA Year of Grad.
HND HND 3.21 2010
Acct. No. Name of Bank Acct. Name
ABEKE EJIRO FREGENE uba 0295680006505
LGA Chairman Sign. Passport HOD Sign. DSA Sign.

Notes:
Print form and attach Passport Photograph
Get identified by getting the LGA Chairman to sign
Get your HOD to validate your GPA and your DSA to Authenticate
Scan to 400x600 pixel jpg format and upload
Uploading jpg that do not meet the above specs can invalidate your Application