*2005412*

APPLICATION FORM

UNIVERSITY ADMISSION ACADEMIC YEAR 2010/2011

APTITUDE TEST FOR THE SELECTION OF CANDIDATES
BACHELOR OF INFORMATION AND COMMUNICATION TECHNOLOGY
DEGREE PROGRAMME

1.Surname with Initials

W.A.K Wickramarathne

2.Full Name

WAIDYARATHNE ARACHCHIGE KSHARAPANI WICKRAMARATHNE

3.Address
151/A,Owala,Kiribathkumbura

4.SEX

5.Results of G.C.E. (A/L) Examination 2010

Index No. 6005411 District KANDY

Z score 0.9097 Contact Telephone No 0715276781

Email ksharapani963@yahoo.com

Subjects offered & Grades(indicate in cage appearing against the respective subject

Higher Mathematics Mathematics/Combined Mathematic S

Physics B Chemistry C
Accounting Business Statistics
Economics Business Studies
Biology Geography
Logic & Scientific Method Latin
Sanskrit Music(Orient,Carnatic,Western)
6. G.C.E. (O/L) Examination

Grade Year
Results for Mathematics A 2007
English A 2007

7.Did you apply for Bachelor of Information & Communication Technology (BICT) as one of your preferences in
the application submitted to the University Grants Commision (UGC)

1. Yes

8.Preferred Examination Center

Kandy
9.Documents to be attached

01.Cash paying-in-slip
02.Cerifed copy of G.C.E.(A/L)2010 Exammination results
03.Cerifed copy of G.C.E.(O/L) Exammination results
04.Cerifed copy of National ID card or postal ID Card
05.Affidavit in support of change in names appearing in different documents/certificate,if any

I certify that the above particulars submitted by me are true and accurate.

.................................... ....................................
Signature of Applicant Date