Edo State Transport Authority
Surname:
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Other Names:
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Phone Number:
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Email Address
National Identity Number (NIN):
*
Gender:
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--Select One--
Male
Female
DOB:
Home Address:
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Office Address:
State of Origin:
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--Select One--
Abia
Adamawa
Akwa Ibom
Anambra
Bauchi
Bayelsa
Benue
Borno
Cross River
Delta
Ebonyi
Edo
Ekiti
Enugu
FCT
Gombe
Imo
Jigawa
Kaduna
Kano
Katsina
Kebbi
Kogi
Kwara
Lagos
Nassarawa
Niger
Ogun
Ondo
Osun
Oyo
Plateau
Rivers
Sokoto
Taraba
Yobe
Zamfara
LGA:
*
--
Identification Means:
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--Select One--
Voters' Card
Driving License
National Identity Card
International Passport
ID Number:
*
Driving License:
*
License Expiry Date:
*
Next of Kin (NOK) Name:
*
NOK Phone:
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NOK Email:
NOK Address:
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Password:
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Confirm Password:
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