PRELIMINARY APPLICATION FORM

FOR THE B. SC. DEGREE / DIPLOMA PROGRAMMES 2012/2013

1. Name with Initials: ..............................................
2. Date of Birth

: Day . Month Year: .....

3. NIC/ Passport No :

4. Postal Address : ...................

......................
5.Contact
Telephone:.................................................
Email:.....................................................................................................................
6. The centre at which you wish to sit the aptitude test:
Colombo

Malabe

Kandy

Kurunagala

Galle

Matara

Jaffna

7. Medium for Aptitude Test:

Sinhala

8. A/L Passed

English

Tamil

Pending
Subjects: 1 23.

Bank receipt for Rs. 750/- paid 1 at the Bank of Ceylon branch/ Sampath Bank at
branch is attached to this application.
I certify that the information given above is true and accurate.
..
Date

...
Signature

Note :
(1) The application fee should be paid at any branch of the Bank of Ceylon in favour of
Sri Lanka Institute of Information Technology (Gte.) Ltd., to the current A/C No.
1630552 at Bank of Ceylon, Kollupitiya or at any branch of Sampath Bank in favour of Sri
Lanka Institute of Information Technology to the current account No. 0039 9000 0033 at
Sampath Bank. SLIIT pay-in-slips are available for this purpose in most bank branches.