Bit Form

Embassy of the Republic of Liberia – Abuja, Nigeria

Liberians Resident in Nigeria Registration Form

Purpose:

This form is designed to register Liberian citizens currently residing in the Federal Republic of Nigeria. Information collected will support consular services, emergency assistance, communication, and community engagement. All information will be kept confidential and used solely for official purposes.

SECTION A: PERSONAL INFORMATION

Full Name

Date of Birth

Gender:

Male

Female

Other...

Marital Status:

Single

Married

Divorced

Widowed

Other...

Liberian Passport Number

National ID Number

SECTION B: CONTACT INFORMATION

Current Residential Address in Nigeria:

City / State

Section

Phone Number (Nigeria):

WhatsApp Number:

Email Address:

SECTION B: CONTACT INFORMATION

Occupation / Profession:

Employer / Institution:

Student:

No

Yes

School/Institution

Business Owner:

No

Yes

Type of Business:

Purpose for Being in Nigeria:

(select all that apply):

Employment

Study

Business

Medical

Transit

Family

Other (please specify):

Date of Arrival in Nigeria:

Duration of Stay (Expected):

SECTION D: EMERGENCY CONTACT INFORMATION

Emergency Contact Name:

Relationship

Phone Number

Address (Nigeria or Liberia):

SECTION D: EMERGENCY CONTACT INFORMATION

Do you wish to join the Embassy’s community updates/notifications?

Yes

No

Do you require any consular assistance?

No

Yes

If Please specify

Comments or Additional Information:

DECLARATION

I hereby declare that the information provided above is true and accurate to the best of my knowledge.

Section

Signature

Pick A Date