Professional Documents
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Coren Proposer Form Updated
Coren Proposer Form Updated
Name:
Address
COREN Reg. No
Academic/Professional/Qualification Status _
Position
(ii)
Name:
Address
COREN Reg. No
Academic/Professional/Qualification Status _
Position
Append your Security Seal here and sign.
**See Sample Below**
**Please fill this form and scan back on the space provided on the portal.
CERTIFICATION BY APPLICANT
I _________________________________________________________________________________________
hereby declare that the information contained in my application is correct and I fully understand the
conditions as stipulated in Decree 55/70 as amended by Decree 27/92 now Act CAP E11/2004 under which
consideration is being given to my application for registration.
Date____________________________ Signature of candidate______________________________________