BNTU New Application Form

First Name (Required)

Middle Name 1 (Optional)

Middle Name 2 (Optional)

Middle Name 3 (Optional)

Last Name (Required)

Date of Birth (Required) When choosing the date on Mobile device click on the year to have the year options instead of scrolling.

Email Address (Required)

Social Security Number (Required)

Bemis Number (Optional)

Phone (Required) Please use the format 1234567 instead of 123-4567

Gender (Required)

Male Female

Marital Status (Required)

Branch (Required)

BNTU ID Please be careful. Your BNTU ID will be generated when you choose a Branch above, make sure that your branch is correct before proceeding.

First Employment Date (Required) When choosing the date on Mobile device click on the year to have the year options instead of scrolling.

Highest Qualification (Required)

School Management (Required) If you are retired please choose Retired.

School Name (Required) If you are retired please choose Retired.

Occupation (Required) If you are retired please Type Retired

License Type (Optional) If you are retired, Junior College, University or auxillary staff please choose None, However if you have your license Number you can provide the information.

License Number(Optional) Format(BZ-YYYY-12345) Make sure to use the dashes and no spaces and also CAPITALIZE the district.

1st Beneficiary (Required)

2nd Beneficiary (Optional)

Street Address (Required) If you dont have a street address kindly type your village,town,city name.

Select Address Type (Required)

Village

Town/City

Village Name (Required)

Town/City Name (Required)

District (Required)

BNTU New Application Form

Profile Information