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Wayamba University of Sri Lanka

1
2
Lional Jayathilake Mawatha, Kuliyapitiya, 60200, Sri Lanka.

APPLICATION FOR ADMISSION OF NEW ENTRANTS

Academic Year : 2020/2021
Faculty Course
Livestock, Fisheries & Nutrition B.Sc. in Food Science & Nutrition
Personal Information

Title Initials Surname (Family Name)

Mr. S Sarmilan

Full Name
SRIKANTHAN SARMILAN

Gender Date of Birth NIC Number Civil Status

Male 2000-04-17 200010803282 Single

Ethnicity Religion Nationanlity Citizenship

Tamil Hindu Sri Lankan Sri Lanka
Geographical Information

Distance Province District

260 km Northern Kilinochchi

Division Grama Niladhari Division

Kandavalai Punnaineeravi

Address
Ulavanoor, Thampirasapuram, Paranthan.&Nbsp;

Contact Information

Mobile No. Home Tel. No. E-mail

0767277301 0775277301 srisarmilan2000@gmail.com
A/L Information

School attended for A/L

2Nd

A/L Index No. Z-score A/L Stream A/L Admission District

4095078 0.4834 Biology Kilinochchi
Bank Account Information

Bank Name Branch Code Branch Name Account No.

Bank of Ceylon 328 Visuvamadu 88869925
Emergency Contact Information

Contact Name
Raththinam srikanthan

Relationship Contact No. 1 Contact No. 2

Father 0775277301 0767277301
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Father's Information

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Father's Name Vital Status

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Raththinam srikanthan Alive

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2
E-mail Contact No. Occupation
0775277301 Business&Nbsp;

Permanent Address
Ulavanoor,Thampirasapuram Tharmapuram Kilinochchi.

Working Address
Tharumapuram

Mother's Information

Mother's Name Vital Status

Srikanthan Nagaraththinam Alive

E-mail Contact No. Occupation

0767277301 House Wife&Nbsp;

Permanent Address
Ulavanoor,Thampirasapuram Tharumapuram Kilinochchi.

Working Address

Guardian's Information

Guardian's Name

E-mail Contact No. Occupation

Permanent Address

Working Address

DECLARATION BY THE CANDIDATE

PART-I

I, .......................................................................................................................................................................................................................
hereby certify that the above information given are true and correct as to the best of my knowledge. I have carefully read and fully
understood the By-Laws No.01 of 2018 relating to student discipline of the Wayamba University of Sri Lanka.

I hereby undertake that;

I will not indulge in any behavior or act that may violate the By-Laws, policies, rules and regulations of the University.
I will not participate in or abet or propagate ragging in any form and sexual & gender based violence.
I will not hurt anyone physically or psychologically or cause any other harm.

I hereby agree that if found guilty of any offence, I may be punished as per the law enforced and By-Laws of the University.
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PART-II

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School candidates : It is mandatory for the candidate to place his/her signature before the principal of the school from

1
where the student sat the A/L examination and certify by the Grama Niladhari of the area of the

2
permanent place of residence and by the Divisional Secretary.

Private candidates : It is mandatory for the candidate to place his/her signature before the Grama Niladhari of the area of
the permanent place of residence and certify by the Divisional Secretary.

I, .......................................................................................................................................................................................................................
have carefully read and fully understood the law prohibiting ragging referred in the Prohibition of ragging and other forms of
violence in educational institutions Act No; 20 of 1998.

I hereby undertake that;

I will not indulge in any behaviour or act that may come under the definition of ragging.
I will not participate in or abet or propagate ragging in any form.
I will not hurt anyone physically or psychologically or cause any other harm.

I hereby agree that if found guilty of any form of ragging, I may be punished as per the law enforced and by-laws of the University.

Signed this on the ......................... day of the month of ............................................................ in the year ............................

Signature of the Student: ............................................................

Name : .........................................................................................................................................................................................

Address : ......................................................................................................................................................................................

UNDERTAKING BY THE PARENT/GUARDIAN

I, .......................................................................................................................................................................................................................
have carefully read and fully understood the law prohibiting ragging referred in the Prohibition of Ragging and Other Forms of
Violence in Educational Institutions Act No; 20 of 1998.

I assure you that my son/daughter/ward will not indulge in any form of tagging.

I hereby agree that if he/she is found guilty of any form of ragging he/she maybe punished as per the law enforced and by-laws of
the University.

Signature of the Father/Mother/Guardian: ............................................................

Name : .........................................................................................................................................................................................

Address : ......................................................................................................................................................................................

I hereby certify that the above information provided by the candidate is true and accurate to the best of my knowledge and signed
before me.

................................................................ ................................................................ ................................................................

Signature of the Principal Signature of the Grama Niladhari Signature of the Divisional Secretary

................................................................ ................................................................ ................................................................

Name Name Name

(Official stamp) (Official stamp) (Official stamp)

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› ,xld jhU úYajúoHd,h

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8
Wayamba University of Sri Lanka

1
2
Lional Jayathilake Mawatha, Kuliyapitiya, 60200, Sri Lanka.

APPLICATION FOR ADMISSION OF NEW ENTRANTS

Academic Year : 2020/2021
Faculty Course
Livestock, Fisheries & Nutrition B.Sc. in Food Science & Nutrition
Personal Information

Title Initials Surname (Family Name)

Mr. S Sarmilan

Full Name
SRIKANTHAN SARMILAN

Gender Date of Birth NIC Number Civil Status

Male 2000-04-17 200010803282 Single

Ethnicity Religion Nationanlity Citizenship

Tamil Hindu Sri Lankan Sri Lanka
Geographical Information

Distance Province District

260 km Northern Kilinochchi

Division Grama Niladhari Division

Kandavalai Punnaineeravi

Address
Ulavanoor, Thampirasapuram, Paranthan.&Nbsp;
Contact Information

Mobile No. Home Tel. No. E-mail

0767277301 0775277301 srisarmilan2000@gmail.com
Emergency Contact Information

Contact Name
Raththinam srikanthan

Relationship Contact No. 1 Contact No. 2

Father 0775277301 0767277301

I hereby certify that the above information provided by me is true and accurate to the best of my knowledg.

................................................................ ................................................................
Date Signature of the Student

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› ,xld jhU úYajúoHd,h

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8
Wayamba University of Sri Lanka

1
2
Lional Jayathilake Mawatha, Kuliyapitiya, 60200, Sri Lanka.

APPLICATION FOR RESIDENTIAL FACILITIES

Academic Year : 2020/2021
Faculty Course
Livestock, Fisheries & Nutrition B.Sc. in Food Science & Nutrition
Personal Information

Title Initials Surname (Family Name)

Mr. S Sarmilan

Full Name
SRIKANTHAN SARMILAN

Gender Date of Birth NIC Number

Male 2000-04-17 200010803282
Geographical Information

Distance Province District

260 km Northern Kilinochchi

Division Grama Niladhari Division

Kandavalai Punnaineeravi

Address
Ulavanoor, Thampirasapuram, Paranthan.&Nbsp;

I hereby certify that the above information provided by me is true and accurate to the best of my knowledg.

................................................................ ................................................................
Date Signature of the Student

CERTIFICATION OF THE GRAMA NILADARI

I hereby certify that the above information provided by the candidate is true and accurate to the best of my knowledge and signed
before me.

................................................................
Signature of the Grama Niladhari

................................................................
Name

(Official stamp)

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