980 gcle® og sated Sac eneb/ mastonamiud) Upsirh SoasuTs ee ences woe Orde GEBOEH an crmDBOEE amd, Bas doomDn exkes BBP dm ON, OF etmnden Bre SS nem 8 Se coaicee Bod moti DOS. 8 8 goo Date gm eHlOgs mow wBe! Dag goes DoD cee (Ges Jo | 83 / oc) dn 88 G gacrabe Bodtb c:60 8 apm-PewBalah obs Bred aus mac Gee 0 seid gate G58. dad Geeo qacnamnoed Qowend § geatade! HOW com Cugean oe Rad wee BgeGa aEa OO OD BO ga HOE. tet ee Ce a oe erry Enjoy the best rates from Mobitel while you roam across the world Coenen teersalotancugtulet Tye ond Cursspei Genin Ga ofa) rat asin hem gonn-Gouk eating as ab Gatos / mek Gish aie og) psitanomns / omens Bre wna Cuneo, setae / 6s909 pay MILLA, en) sNeEAGONED OMG HURUAED arePACend dae® Guiuahme aduane os Bsinrenet aaimommarsann slanemilsasisinas achiamy Bare * o-Piemy bn Bigs soetsscunsty ub Gass at mvAcon / owas) oUsghRD / seme wnoNd snap Bel) Bb yb ade Bode acer soph bancmuse / sing aehingamense / oi snae aekbnjamesya regio Soumpgmra. Ann. ae ah 9 Op hata Jesoniss oiSanssh baste) glum satel CpaNNSN, Bhs ch Bashan GHe vse a[sen sky IBBunSaC ge ud, Seiarpia aisieGuione Gigs Sidupdsis dame aoteNAoACUlely sulaTSst eden sump Hace Gost, 8 clatemuiLnapgLet Smarisinighe qeanisc eatmouneTh shone eatawuNeT curimE wOMERD Opn. Qnstunst “Samra Sean PEED © USHgT LL Taso osuR © auNOALA, ee ee ee ee ee a psianad! 0 wap aiiunsane Cups Sse Lam SAUpIN) e ailRySERGNS 98 omcisrin orks Gastpr OS aeRIAACEMe aLoligiai cloiaihTéesd 8 ation BS) Bau / Ores 7 ow fon “tn pret fetal gs SoutBunh> Grams dpa eis Shusiny Aamssnpsin egy seclIed seLuiaigegs Cisps GerGidieh Maus Bas aa BUSIeAOps svn soonpha Sul Tresdo Grvteanlgigs Cautltupmg: pecnG0 wpeee engl aLaBAQ Geunigaad Grits amiep pam peg, oben. Client Undertaking (Please cut of the inapplicable words) | eclare that lam a elzen of Sri Lanka I hold Dual Citeenshipof Sei Lanka am actizen of (tte the name of the county) | cetiy that have not previously held or applied for any Passport, Emergency Cerise or an Identity Certs |Loorty that all provous passports, Emergoney Corea or an idoniy Cotfctos held by my name have beon surrandored to the SriLankan Passport ‘Autores for cancellation, other than the passoot’ Emergency Cerificate isnt Cerficate No: "ahi snow submited ane Ihave made no ater appteaton since te one attached was Isued to me | certify that te information furishe in his aplication and documents attached to this application are tue and correct and no aeration, medications orfalaicatone were carsad out hide or delle: ru acta, |oerty that axed photographs are depicting the natural status of myself without disguise or concsalmant and were akon wih nthe last ee months. "iN. Nsw residing at applying fora” passport” thvough "Si Lanka Mission in “hereby underiake to provide my fingers tothe Deparment prior to my deparure fam Sr Lanka. | “ndersiand the flare todo so wil cause my passpor to become Inactive, pravening my departure from Sr Lanka. ‘sein Baio ad piace eogtesena qe Signals lhe Appicant Pub, Bi Sobonct pide atta a eer Sate 88a, cm Gao (08 op oogne! aa ees gas! (ad songs gi800 Bdoin50 qyP qe Meoc Dee oD Cac ardnce aes Bod qapfRend Dee yam HO ae GERD HoRse BOR NH BOM, ‘aoetinde fo qaloe ® ENO & ee ee 00 ¢ an 008, alataniups) Gpm purer andi pans acted aati atte) cog efi MSHS, plUlseondgw cig aos, eatonuuzaferse spuGstor sluytosN eonewuraTO este, slanonupnfulonsS NIpEACUGH CYS HfuraGaend opal AE RASS. adetenpnh ab bat (Bo amps a (patatemade ajar aaGeninthen, Qa) sahumpats cage Si Sigise oeCertificate Regrading the Applicant (No fois chargeabe for tis Crticato) To the best of my personal knowledge ana ete, the formation given bythe appieantis tue and the declaration made above by the appears accurate. Pigpoicon acd thar sont nfo freon (Date) at Bade yo Weteg Ho! Overseas Mission Seal Gautyn'sh gs a HsduNNUte Be whi bags go ening Oecge Hoitcomd ac! ‘Signature of OM Authorized Ofte? a9 ogaond Goi «B6Ounappfed emacs el Bate ag (oborgde gealdos exam (oaiome 2 Lies Spe impr) (For Office use only) Bele uo eating ates Gastar Medes ersrebbe peer Recommendation ofthe Overseas Sri Lankan mbaede Qualia eam /ewmns #_ubunssBie wrssmi/ For Office use only Spocial Reference to Controller / DC 1. ACALTIOE 2. NIC OF/ Double (Oerent/ Same) ‘3. Appearence (Diferent Under Age Above Age) 4, Blac Listed: 1D/ PPT? BC or ther reason A's Signature PPT Ne PPT Lost: Yes! No BC No Distt: NiCr BL Postal 1D MeNo Parents PPT copy! NIC/ Consent Letter ‘es Order