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Confirmation Order No
FEDERAL POLYTECHNIC, NEKEDE
(P.M.B. 1036, OWERRI, IMO STATE)
OFFICE OF THE REGISTRAR
RE-ADMISSION & UNDERTAKING OF GOOD BEHAVIOUR FORM
To be completed and sworn in Quadruplicate by all Old Students
(NDI, NDII, HNDI, HNDII ) 2010/2011 Academic Session as condition precedent for
their further studentship of the Institution.
I_______________________________.(Mr, Mrs, Miss)
Full Name of Student, Surname first
Of_________________________________________________
Registration Number__________________..Phone No______________
Department _______________________________________________
Email Address______________________________________________
Year of Study/Programme_____________________________________
Hall of Residence (or off Campus current Address)__________________
Name and Address of Landlord_________________________________
Phone Number of Landlord:____________________________________
(off Campus Residents only)
Permanent Home Address_____________________________________
Do hereby and herein willingly and solemnly swear/declare that I,
1. Will be of good behaviour throughout the remaining period of my stay in this
institution and shall never plot, participate, engage or condone any acts in my
surrounding which is inimical to good scholarship or wellbeing of the
Polytechnic.
2. Will show evidence of payment of all outstanding school fees including that of
this current academic session.
3. Will submit myself to be bound by the above presents, willingly, of my own
free will and accord, without any equivocation or mental reservation whatever
as a precondition to my re-admission into my academics in the Federal
Polytechnic Nekede, Owerri.
4. Accept that any deliberate false information supplied herein disqualifies me
from being a fit and proper person worthy of the institutions certificate.
5. That if I_________________________________..disobey
any of the set rules and regulations of this institution should be dismissed.
Affix your
recent
Passport
Photograph
Dated this_____________________. day of___________________________.2011.
__________________________
SIGNATURE OF DEPONENT/DECLARANT
SWORN TO/DECLARED AT,__________________________________________________________________
COURT REGISTRY, THIS_________________________DAY OF___________________________ 2011.
BEFORE ME,
COMMISSIOER FOR OATHS.
AFIRMATION BY PARENT/GUARDIAN
I,_________________________________________of________________________
Email__________________________Phone ___________________________
Parent/guardian of the above named __________________________________
Student of the Federal Polytechnic Nekede, Owerri hereby attest to the good
character of my said ward, the authenticity of the facts he deposed above, and
further undertake to ensure that he will be amenable to the Rules and Regulations of
the Institution as a precondition for his continued studentship of the Institution.
Signed ________________________________________ Dated ____________________________
Relationship to the Student_______________________________________________________
AUTHENTICATION OF DATA
The above personal data of the above named student is hereby authenticated by
(1) __________________________________________________ _______________________________
Name of HOD Signature, Stamp & Date
(2) __________________________________ __________________ _______________________________
Name of Dean of School Signature, Stamp & Date
DOCUMENT SUBMITTED:-
1 Four recent passport photographs of the student (compulsory)
2_________________________________________________
3_________________________________________________
4_________________________________________________
e.g. Photocopies of___________________________________