Registration Form

COMPETITIVE ENTRANCE REGISTRATION

Entrance Exam Code LIC-ANU-1

Year 2023

Field* :

Examination language* :

Examination Center*:

PERSONAL INFORMATION

Name* :

Surname :

Date of birth* :

Place of birth* :

Sex* :

Nationality* :

Region of Origin* :

Department of Origin* :

E-mail :

ID/Passport* :

Telephone* :

Name of Parent* :

Parent's Telephone Contact* : (Pas d'espace. Ex: 6xxxxxxxx)

Post Box :

City of Residenc* :

Diplôme d'entrée

Subject Owing BAC/ GCE A/L?

Certificate holder BAC/ GCE A/L?

Section

French Section?

English Section?

PAYMENT DETAILS

Important Mark to read:
If the date and name of payment Agency do not appear after typing the payment reference number, it will mean that your payment is invalide. Check out if your names are in the same order as on the payment receipt or you go back and lay a complaint at the Agency where you made the payment.
Click on the Verify button after typing the number to validate or Update in case of any mistakes.

Bank* :

Transaction number* :

Summary

Competitive entrance registration

Entrance Exam Code :

Year :

Examination Center :

Examination language :

Personal information

Name :

Surname :

Date of birth :

Place of birth :

Sex :

Nationality :

Region of Origin :

Department of Origin :

E-mail :

ID/Passport :

Telephone :

Name of Parent :

Parent's Telephone Contact :

Post Box :

City of Residenc :

Entrance diploma

BAC Series :

BAC Session :

BAC Average :

Subject Owing :

Etablishment :

payment details

Bank :

Transaction Number :

Date and time of the transaction :

Payment agency :