Official use only

Date: 17/05/2021 12:42:03

Application Reference: EED965
Department of Examinations, Sri Lanka.

Qualifying Examination for Recruitment of Barcode #: 0000037900

Customer Service Assistants to People's Bank - 2021 Serial #: 0000014129

(1). Exam Town, Province, District and The Subject/Medium applied for the vacancy

(I). Select the Town applied to sit for the Examination

Galle

(II). The Province applied for the vacancy

Sothern Province

(III). The District applied for the vacancy

Galle

(IV). The Medium applied for the Examination (Candidates should sit for the Examination only through
the medium mentioned here)

Sinhala

(2). Personal Information

(I). Name in Full (IN ENGLISH BLOCK CAPITALS)

JAYASEKARA KARUNANAYAKA MUDIYANSELAGE CHATHURI NIMESHIKA

(II). Name with last name first and the initials of the other names at the end (IN ENGLISH BLOCK
CAPITALS)

NIMESHIKA J.K.M.C

(III). Current Address without Postal Town - Admissions will be posted to this address (IN ENGLISH
BLOCK CAPITALS)

AKKARA 10, WOODLAND ESTATE, BERATHUDUWA ROAD, GONAPINUWALA.

(IV). Postal Town of the Current Address (IN ENGLISH BLOCK CAPITALS)

GONAPINUWALA

(V). National Identity Card Number

987861932v

(VI). Telephone Number (Mobile)

0761236864

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(VII). Telephone Number (Fixed)

(VIII). Gender

Female

(IX). Date of Birth

October 12, 1998

(X). Age as at 02.06.2021

22 YEARS 07 MONTHS 22 DAYS

(XI). Marital Status

Single

(3). Minimum Educational Qualifications (Conditions)

(I). Have you passed the G.C.E. (Ordinary Level) Examination with following conditions ? Should pass
minimum of 06 subjects at G.C.E. (Ordinary Level) Examination with at least 05 Credits passes in one
& the same sitting. It is compulsory to possess Credit passes for Sinhala/Tamil Language, Mathematics
and English language.

Yes

(II). Do you have minimum 03 simple passes at G.C.E. (Advanced Level) Examination in one & the
same sitting (Excluding General English) ?

Yes

(4). Educational Qualifications - G.C.E. (Ordinary Level) Examination

Year : ___________ Index Number : _____________________

Subject 01: _______________________________ Grade: _________________

Subject 02: _______________________________ Grade: _________________

Subject 03: _______________________________ Grade: _________________

Subject 04: _______________________________ Grade: _________________

Subject 05: _______________________________ Grade: _________________

Subject 06: _______________________________ Grade: _________________

Subject 07: _______________________________ Grade: _________________

Subject 08: _______________________________ Grade: _________________

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 Subject 09: _______________________________ Grade: _________________

Subject 10: _______________________________ Grade: _________________

(5). Educational Qualifications- G.C.E. (Advanced Level) Examination

Year : ___________ Index Number : _____________________

Subject 01: _______________________________ Grade: _________________

Subject 02: _______________________________ Grade: _________________

Subject 03: _______________________________ Grade: _________________

Subject 04: _______________________________ Grade: _________________

(6). IT Literacy and Other Qualifications

Qualification obtained : _______________________________________________

Institute awarded : __________________________________

Effective date of the Certificate : ______________

Main subject/subjects followed : _________________________________________________________

____________________________________________________________________________________________________

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____________________________________________________________________________________________________

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(7). Non- Related Referees

(I)

Name : _______________________________________________________

Address : __________________________________________________________________________________________

Contact Numbers : _________________________________________________________________________________

(II)

Name : _______________________________________________________

Address : __________________________________________________________________________________________

Contact Numbers : _________________________________________________________________________________

(8). Certification of the applicant

I do hereby declare that the particulars furnished here are true according to my knowledge and
belief. At any stage of the recruitment if it is revealed that I do not possess the required eligibility
criteria, I am aware that I am disqualified and I cannot hold the position. I am aware that I will be
dismissed from the service if it is revealed that I am not eligible to be appointed to this Post after
being selected to the post. Any information mentioned herein will not be altered later. Further, I
agree to be bound by the rules and regulations imposed by the Commissioner General of
Examinations on conducting the Examination and the issuance of results.

Signature of the Applicant : ______________________________________

Date : ____________________________________________

(9). Attestation of Signature of the Applicant

I certify that Mr./Mrs./Miss ________________________________________ Submitting this application is

personally known to me and he/she placed his/her signature before me on ______________________

Signature of the officer attesting the signature : _________________________

Date : _______________________

Full Name of the attesting officer : _______________________________________________________

Post and Address (Confirm with the seal) : ___________________________________

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 Official use only

Payment Information

NIC 987861932v

Application Reference EED965

Payment Type Post office payment

Payment Date and Time 17-05-2021 18:08:40

Qualifying Examination for Recruitment of Customer Service Assistants to

Exam Applied
People's Bank - 2021

Exam Fee 600.00 LKR

Total fee Paid 600.00 LKR

In accordance with section 3 of the Electronic Transaction Act No.19 of 2006, electronic version of the bill has the same validity as a conventional bill.

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