NYSC SECRETARIAT , FEDERAL SECRETARIAT, UYO

FINAL CLEARANCE FORMAT

State Code:…………………………………………
Call Up No:………………………………………….
1. Name of Corps Member……………………………………………………………………………………………………………………………….
2. Qualification :………………………………………………………………………………………………………………………………………………
3. Discipline …………………………………………………………………………………………………………………………………………………….
4. State of Origin………………………………………………………………………………………………………………………………………………
5. Institution of Graduation……………………………………………………………………………………………………………………………..
6. Next of Kin……………………………………………………………………………………………………………………………………………………
7. Address of Next of Kin………………………………………………………………………………………………………………………………….
8. Relationship…………………………………………………………………………………………………………………………………………………
9. Phone No. of Next of Kin………………………………………………………………………………………………………………………………
10. Orientation Posting………………………………………………………………………………………………………………………………………
11. Reposting if any …………………………………………………………………………………………………………………………………………..
12. Relocated from…………………………………………………………………………………………………………………………………………….
13. Name of CDS group…………………………………………....(B) CDS Supervisor………………………………………………………….
Attach clearance from supervisor please
14. LGI’s Name………………………………………………………...LGA……………………………………….Zone…………………………………
15. Disciplinary case
(a). Pending case………………………………………………………………………………………………………………………………………….
(b). Decided Case/Penalty……………………………………………………………………………………………………………………………
16. a. Place of Primary Assignment…………………………………………………………………………………………………………………..
………………………………………………………………………………………………………………………………………………………………………..
b. Employer’s Comment on Cm’s Performance………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………………………….
c. Debt owned (if any)………………………………………………………………………………………………………………………………………
Signature of Employer/Date…………………………………………………………………………………………………………………………….
TO ALL EMLOYERS
The signing of this form notwithstanding, report any erring corps member in your employ to NYSC for
necessary disciplinary action before the Passing-Out ceremony.
Zonal Inspector’s comment……………………………..………………………………………………………………………………………..
………………………………………………………………………………………………………………………………………………………………….
Zonal Inspector’s signature/Date………………………………………………………………………………………………………………
17. Account Matters
Please specify if you are owed by NYSC………………………………………………………………………………………………………..
How many months……………………………………………………………………………………………………………………………………….
State reason…………………………………………………………………………………………………………………………………………………
Have you applied for it?....................................................................................................................................
Account No./Bank………………………………………………………………………………………………………………………………………..
Accounts Comment………………………………………………………………………………………………………………………………………
Signature of Officer/Date……………………………………………………………………………………………………………………………..
Note: All Corps Members
Please attach the following documents before submission for official use.
1. Final clearance letter from supervisor.
2. CDS discharge clearance letter from supervisor.
3. Photocopy of NYSC ID card.
4. Photocopy of posting letter.
Thank you

Mr. Umoren K
For: State Coordinator