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Replacement Form

The document is a request form for a replacement residency card from the Lagos State Residents Registration Agency. It requests information such as the applicant's name, registration details, reason for replacement, and payment of a 500 Naira fee. The form provides instructions on submitting supporting documents depending on the reason for replacement and where to submit the completed form.

Uploaded by

Olatunji Adebisi Tunde
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169 views

Replacement Form

The document is a request form for a replacement residency card from the Lagos State Residents Registration Agency. It requests information such as the applicant's name, registration details, reason for replacement, and payment of a 500 Naira fee. The form provides instructions on submitting supporting documents depending on the reason for replacement and where to submit the completed form.

Uploaded by

Olatunji Adebisi Tunde
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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REQUEST FOR REPLACEMENT THE LAGOS STATE RESIDENTS

RESIDENTS CARD REGISTRATION AGENCY

Complete the following: Attach recent


passport
Registration Number: photograph

Place of Registration:

Type of Registration: Adult( ) Child ( )

Date of Registration:

Method of Registration: Direct ( ) Online ( )

Surname: First Name:

Other Name:

Date of Birth(dd/mm/yyyy): Gender:

Contact Tel: Email:

Current Address:

I certify that I require a replacement card/residency number for the following reason (tick box):

Lost [ ] Destroyed [ ] Stolen [ ] Name Change [ ] Error [ ] Phone Number Update [ ]

I understand that any attempt to fraudulently obtain a registration/resident card/resident number will be dealt with
under the law and or referred to law enforcement agencies.

Signature of Applicant Date


…………………………………………………………………………………………………………………………………………………………………………………….
IF YOUR CARD HAS BEEN LOST, DAMAGED AND OR NEEDS TO BE RE-ISSUED, a N500.00 replacement fee applies.
Please make payment to the Lagos State Residents Registration Agency and attach the payment receipt to the completed form.
Payment should be made by direct deposit or bank transfer to LASRRA bank account.
(Please use the Agency & Revenue codes when making payment)

BANK NAME: GT BANK


ACCOUNT NAME: LASG CONSOLIDATED REVENUE
ACCOUNT NUMBER: 0176319468
BRANCH: ALAUSA
AGENCY CODE: 4240000
REVENUE CODE: 4020088
DESCRIPTION: E-CARD RE-ISSUANCE

APPLICANTS MUST PROVIDE THE FOLLOWING EVIDENCE OF IDENTITY AND RESIDENCY:


IF YOUR REQUEST IS DUE TO YOUR CARD BEING STOLEN
You will need to provide a police report on the stolen card.
IF YOUR REQUEST IS DUE TO A NAME CHANGE
You will need to provide a certified documentary evidence to support the change of name.
Drop off form and attach the necessary evidence document(s), with payment teller/Revenue receipt to the LASRRA
HEAD OFFICE AT 4, Registration Close, Off Lateef Jakande Road, Agidingbi Ikeja.
For additional information, please contact
Helpdesk: 01-4483440/450 Email: [email protected]

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