Student Referral Form

Date:

To be filled by the IIHS student:

1. Name : Minoshi Peiris

2. Registration Number at IIHS : HDN01040

3. Name should be mentioned in your cheque : v.Minoshi Peiris Pulle

Prospective Student Details:

4. Name of the Prospective student : Oneli Peiris

5. Course Required at IIHS / Registration No : DGN 07 HDN03014

6. Contact Details of the Prospective student;

0775089610
Tel: Mob: 0761059151
E-mail: onelipeiris22@gmail.com

7. How do you know the above student : my sister

Official Use Only

Referral Acknowledgement Number:

Commission to be paid :

Due Date:

Reference Number:

Note:

 When the new student makes an upfront or a semester payment the stipulated
commission will be paid upon registration.
 If the new student opts for a monthly payment plan, the stipulated commission will
be paid after the new student pays 3 months tuition fees to IIHS.
 Prospective student you introduce should have had no previous contact with IIHS.
(This can be traced through the IIHS inquiry system)