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CAPACITY BUILDING CONSULTANT (CBD) FORM

DELTA STATE MICRO, SMALL & MEDIUM ENTERPRISES DEVELOPMENT AGENCY

(DEMSMEDA)

Olorogun Felix Ibru Secretariat Annex, Mariam Babangida Way Asaba

    Registration status?---> Limited Liability or Business Name Registration No Date of Registration Area of specialization Company Address Company Phone Number Company Email Number of Staff Training Objectives/Purposes Duration of the Training Certificate Issued after Training?---> Yes or No Full Name (Surname First) Date of Birth Contact Address Phone Number Gender ?---> Male or Female Educational Qualification Field of Study Membership of Professional Body (if any) state LGA of Origin Means of Identification ?---> National ID card or Voters Card or International Passport or Driver’s License DECLEARATION I…………………………………………………………………………………………………………………Hereby declare that all the above information are true and verifiable and that any false and/or misleading information given by me shall lead to automatic disqualification.