ECM Device Allocation Registration Form
Surname:
First Name:
Other Name:
Date of Birth:
Date of 1st Appointment:
Date of Confirmation of Appointment:
Date of Present Appointment:
IPPIS No.:
Whatsapp No:
Email:
Grade Level
Select Grade Level
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
Department/Unit
Designation
Device type
MAC ID
Device Color/Seriel No.
Passport Photo (allowed file type Image / PDF):
Submit
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