COUNCIL FOR THE REGULATION OF ENGINEERING IN NIGERIA

22 Addis Ababa Crescent Wuse Zone 4

P.O.Box 8461, Wuse, Abuja.

PROPOSERS' CONFIRMATION FORM

*TWO PROPOSERS (Must be on COREN register and up-to-date in the payment
of their dues to COREN). We hereby certify to the best of our knowledge that:

Mr/Mrs/Miss is
of good character and is fit and proper to be placed on the register of Council for the
Regulation of Engineering in Nigeria and therefore propose him/her to the Council.

(i) Name: _
Address
COREN Reg. No
Academic/Professional/Qualification Status _
Position

Append your Security Seal here and sign.

**See Sample Below**

(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

SAMPLE SECURITY SEAL