TRAINEE BIO DATA – National Obstetrics Fistula Centre, Abakaliki

OFFICE OF THE HEAD CLINICAL SERVICES

INSTRUCTION: Review your details before submission, there is no room for multiple submissions.

Name of Trainee

Home Address

Date of Birth

Marital Status

Gender

WhatsApp Phone No

State

LGA

School/Hospital/Institution

Head of Institution

Discipline/Area of Training

Contact No

Training Commencement Date

Training End Date

Training Expectations

Passport

Confirmation

I hereby undertake that my submission is accurate, i accept liability for any error that my submission may contain.