me DPIAL/2008'5 Specimen Application Form For Private Candidates (GENERAL CERTIFICATE OF EDUCATION (ADVANCED LEVEL) EXAMINATION APRIL ~ 2005 (Read tne Newspaper advertisement before filling his form) ‘Use your own hand writing Tor Oise we oni) 01, Town seleced wicca tones [7] 2, Full Name: @ InEnglish Gi) In Sinhala amit ie (Do not write your name with initials only) 3, Adds in Ealish (i) In inate 04, () Dsteof Binks Yew: Mont oe | (i) Azeas 01012005 Year Mont ey: LI 05. subjects ale for and sje Nx . Subject ubi.No, ae ‘Subi.No, re » 06, Tul mune of sbjcs applied for 7. inten Card No ot, —_Fespuin wor) (tig) 4s. —] 8, Gone Male (0) Fenalo(t) [7] Wo. Language Medium: Sina 2) Tami @) Eaglsh (© Me aces Gaal 12. Haveyousempted No 16of his aplication in spc of te Csiftion ofthe Pina or a Teather, tthe effet th ractical test projects have boen complete: 13, Cortifeaton ot Ident oF [serif thatthe applicant fs known tome personally, and thatthe etal furnished in cages 01,6, 26 07 08 an Larch te cade placed hse signature in my presen. Signature of Candida Signature of Auster Date: Nan: : Designation: (Place Rubber Stamp here) Address: : Dave4 teow dt ve ett Rape eons) Gof on. os Of Pos Oe sd obit Rep Ne. R 15. Cenitication of Candidate ] = ee ee top Novela at Fore |S io ani Subj | ote = ‘Examinstion | GOR | 120 | T6OF | BAO | 300 Fees Re iaasres erby declare andar that (the partculrs liven nin hieapplieaton are te and cores, {Bhat | agree t bie by the ules and Fepultons impose bythe Pubic Examinations ‘Ae ncsoset of examination candies (3) an that Spce to aide bythe decisions ken by the | {Commtsicnes Gener of Examinations epurcing ese in this ag the cept obained fom the Post Offer forthe pert of canination fs. Keep a photocopy of the receptor Due, Number ng the Name othe Post (Ofte) wi 0 Ute vigil esi is nt pastes your application wil be this earination reese 1, Ifyou sk en 10 a University you must sitthe Common (Signatur of Candidate) General Test agar" And if you lait that you would nos his | paper nce tos wld late be aod at: | 16 Cena the Pini and th Subjet teaches ofthe school where ih anda siting forthe irs tm has een inset with fr hs PaccaVAssigamens Proje ~ a Tobe ‘Se far Seid |Site: supe complied | complet so ONS che be gam i i g 2 EB gz \2 | s 3 & i 2 |2 a w or) > Iceni a bsp sa she Sco Anviesan Pitts Brauch ef ne Miasiy_ oF dston under te rgiraon No, and has besn dst fo my Schoo bass othe Cras No. (2200! vated 3801 200, ofthe Secreary of Education, ula al se requirement needed fo siting GCE (VL) a, purus given a No, 16 are ue a ert. at alin ‘Signe of the Ppa ‘ame ad te Adis oe School ical Stamp |