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NIC No : 200263700952
Name in Full : Sembukutti Arachchige Don Kushani Irushi Imasha
Name with Initials : SADKI Imasha
Address : 681/C Kunjawatta,Bopitiya, Pamunugama
District : Gampaha
Divisional Secretariat : Ja-Ela
Nearest Town : Ja-Ela
Telephone-Residence : 0777347642
Telephone-Mobile : 0774001079
Telephone-Office :
Date of Birth : 2002-05-16
Medium : English
Email : imakushani@gmail.com
Other Qualifications :
Payment Details
Bank branch : Negombo
Paid Amount : 3000 Date : 2022-Oct-28
Note:
1. Name should be written according to the Birth Certificate.
2. ZScore should be indicate as Plus or Minus(+/-).
3. Following documents should be attached with this Application Form.
a. Certified copy of Birth Certificate.
b. Certified copy of National Identity Card.
c. Certified copy of GCE A/L Certificate- Affidavit (If there is a change in name).
d. Certified copy relevant certificate for Other Qualifications.
e. Customer copy of receipt paid to People's Bank / Evidence for Payment.
( √)
I declare that the information given by me in this application is true and accurate.
...................................... 2022-Oct-29
Signature of Applicant Date