JUTH IPPIS ENROLLMENT FORM

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Urgently fill this form if you are a Staff of Jos University Teaching Hospital whose name appeared in the list sent to all the departments or who is yet to be enrolled on the IPPIS platform. CAREFULLY AND ACCURATELY FILL FORM IN ALL CAPITAL LETTERS PLEASE. THANK YOU.

Title *

Surname *

First Name *

Other Name

Department *

Gender *

MALE

FEMALE

Marital Status *

Email Address *

Residential Address *

Permanent Address *

Phone No *

State of Origin *

Local Government Area *

BVN (Biometric Verification Number) *

PFA (Pension Fund Administrator) Name *

PFA PIN *

Staff Number *

Next of Kin's Name *

Next of Kin's Phone *

Relationship *

Next of Kin's Address *

Submit

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