1.

Personal details
a. Name with Initials :
(Prof./Dr./Mr./Mrs./Ms./Miss)

b. Surname :

c. Other Names :

d. Date of Birth :

e. National Identity Card No. :

f. Affix a passport size recently

taken coloured photograph
in next space and an Affix your photo
additional copy with your
name written on back side of
the photo.

g. (i) Permanent Address in Sri

Lanka :

(ii) Telephone Residence :

h. Contact telephone Residence Mobile Office

j. Communication Details : Address :

Enter details where regular
communications should be
addressed to. All
correspondence will be
addressed to this address,
telephone, fax and e-mail. Email :

k. Present Occupation:

m. Office Address:

Page 1 of 2
n. Office Telephone Office Fax : Office E-mail :

Page 2 of 2