Mahapola Scholarship Recipient Registration Form

Scholarship Recipient's Declaration and Bank Account Details - Academic

Year 2019/2020

Student Details

Full Name: SIRIPRAKASH GEETH ADITHYA

Mahapola Scholarship No: 2470
National Identity Card No: 200011903193
Advanced Level Index No: 6159184
University / Institute: UNIVERSITY OF PERADENIYA
Course : BIOLOGICAL SCIENCE

Bank Account Details

Name of the Bank : Peoples Bank | Bank Code : 7135

Branch Name : Seeduwa | Branch Code : 324
Account No : 324200100026441
Name of the Account Holder: ADITHYA SIRIPRAKASH GEETH
(Please submit a clear certified copy of the passbook / bank statement herewith)

Scholarship Recipient's Declaration

I do hereby certify that the bank account details submitted above are from a bank account in my name and I agree to credit
the monthly Mahapola Scholarship Installment to that account. In any case, if this bank account is changed or if a new bank
account is opened, I do further agree to send the details of that new bank account, immediately, to the Mahapola Scholarship
Trust Fund through the university / institute. I understand that, I am not entitled to receive any other scholarship,
employment or engage in any other course. In receive an employment I will inform immediately to the director, Mahapola
Higher Education Scholarship Trust Fund. I further declare that the all the details given above are true and accurate.

.................................................
Signature of the Scholarship Recipient

Certificate of the University/ Institute

We do hereby certify that the student ADITHYA S.G. who is bearing NIC No 200011903193 and Student Registration No
............................................... is an internal student of the University / Institute, and the bank account details submitted by
him/ her is correct. (Please attach a clear copy of the Bank passbook)

...................................................... Date:
...............................
Registrar/ Director
(Please affix your seal)