primary%3Abluetooth%2FApplication_2020_2018_3407489

Ministry of Education (Higher 2020/3407489/18/02512 Education) Interest Free Student Loan Scheme for Selected Degree Programs 2018 / 2019 / 2020 Application for Higher Education Admission Personal Details Name with Initials PREMACHANDRA M.D.S.D. Full Name Civil Status MANNAGE DON SOHANI DIMALKA PREMACHANDRA Date of Birth NIC Number SINGLE Gender FEMALE Mobile Number Ethnicity 1999-09-24 Place of Birth ANURADHAPURA Citizen by Descent 997680936V NIC Issue Date 2015-09-24 0711936393 Email [email protected] SINHALA Religion BUDDHISM YES Residency Details Permanent Address of Residence 01, MAHAMEEGASSAGAMA, MAHAILUPPALLAMA Period of Residence this Address up to YEARS - 20, MONTHS - 8, DAYS - 7 31st July 2020 ANURADHAPURA Fixed Number 0763340305 Resident District Name of Father Parents / Guardian Details Name of Mother M. D . PARAKKRAMA PREMACHANDRA N.W.INDRANI BUDDHILATHA NAVIMANA 1

Contact Person Details Name of Parent/Guardian N.W.INDRANI BUDDHILATHA NAVIMANA Address of Parent/Guardian Mobile Number 01, MAHAMEEGASSAGAMA, MAHAILUPPALLAMA 0711611687 Fixed Number 0763340305 G.C.E.(A/L) August 2018 Results Subject Grade Medium Z-Score District INFORM.&COMM. TECHNOLOGY C BIOSYSTEMS TECHNOLOGY SCIENCE FOR TECHNOLOGY C SINHALA 0.8041 KANDY GEN.ENGLISH C CGP C Used ID Type Used ID Number Candidate Type 43 Index Number NIC 997680936V SCHOOL Stream 3407489 BIOSYSTEM TECHNOLOGY G.C.E (O/L) Results Year Index No ENGLISH MATHEMATICS SCIENCE SINHALA 2015 53740882 A C C A G.C.E (A/L) Details AL Year that obtained best CGP Marks 2018 Best Common General Practitioner Marks obtained 43 2

Order of Degree & Institute Preference Order Institute Degree 1 SLTC BACHELOR OF TECHNOLOGY HONOURS IN ENVIRONMENTAL 2 SLTC TECHNOLOGY 3 AQUINAS BACHELOR OF TECHNOLOGY (HONOURS) IN AGRICULTURAL 4 HORIZON TECHNOLOGY 5 CINEC 6 SLTC BACHELOR OF SCIENCE (HONOURS) IN AGRO INDUSTRY MANAGEMENT BACHELOR OF SCIENCE HONOURS IN BIOTECHNOLOGY BACHELOR OF EDUCATION (HONOURS) IN INFORMATION TECHNOLOGY BACHELOR OF SCIENCE IN TEXTILE AND CLOTHING TECHNOLOGY Declaration NO NO Were / are you registered at any times as an internal student of any institution mentioned in the Guideline? Have you received a foreign scholarships channeled through the office of the Ministry of Higher Education to follow a course at First Degree level at any time? i. I certify that all particulars given by me in this form are true and accurate. I am also aware that if any particulars given by me in this application are found to be false or inaccurate prior to my admission , my application will be rejected and that if such information is found to be false or inaccurate after my admission, I will be dismissed from the Higher educational institution concerned. ii. I declare specifically that information given by me in section 7 above as regards the total number of attempts at the examination specified therein is correct. iii. In the event of my being selected for admission, I shall abide by the Statutes, By Laws , Regulations and Rules of the Higher Educational Institution concerned in so far as they are applicable to me, pay due respect to the teaches and the officers of such institution and conduct myself in a manner which will in no way be prejudicial to the good name of such institution. .............................................................................. .............................................................................. Date Signature of Applicant 3

Principal's Certificate Name of School and Address K /ALAWATUGODA M.M.V.,ALAWATUGODA. Administrative District KANDY School Tel No 0812302603 Name of Applicant MANNAGE DON SOHANI DIMALKA PREMACHANDRA G.C.E.(A/L) Index No of the 3407489 Date of Admission of the 2016-05-18 Applicant (August 2018) Applicant to school I have personally checked / checked & corrected the particulars furnished by the above named candidate with reference to school records and I hereby certify that such particulars are true & correct and that I have carefully scrutinized the application of this candidate from my school. .............................................................................. Date .............................................................................. .............................................................................. Signature of Principal Official Stamp of Principal Checked By For Office use only Date Signature 4