Application

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*2393111*

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


KUBETHIRA.S

2.Full Name

SEELARATNA KUBETHIRA

3.Address
165/B,,TEMPLE ROAD,,KALMUNAI-02

4.SEX
Male

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


Index No. 6393110 District AMPARA

Z score 0.7278 Contact Telephone No 0672225004

Email S.KUBEN1990@YAHOO.COM

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

Higher Mathematics Mathematics/Combined Mathematic


Physics Chemistry
Accounting C Business Statistics C
Economics B 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 B 2007
English B 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


Colombo
9.Documents to be attached

01.Cash paying-in-slip Attached


02.Cerifed copy of G.C.E.(A/L)2010 Exammination results Attached
03.Cerifed copy of G.C.E.(O/L) Exammination results Attached
04.Cerifed copy of National ID card or postal ID Card Attached
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

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