Registration No :- NWP2961072235

Recruitment of Graduates on Provincial Basis for the Class 3 Grade I (A) of Sri Lanka
Teachers’ Service for the Existing Vacancies in the Provincial Council Schools of the
North Western Province

01.District :- Kurunegala 02.Exam Mediam :- Tamil 03.Exam center:- 1-Kurunegala

04.Subject Selection:-

Selection Subject Subject No.

1st Selection: Geography 08

2nd Selection: Mathematics 03

3rd Selection: Tamil language and literacy 05

5.1 Name with Initials(S/T) :-எம்.ஏ.எஸ்.பஸீனா

5.2 Name with Initials(E) :-M.A.S.FAZEENA

5.3 Name in Full(S/T) :-முஹம்மது அப்பாஸ் சித்தி பஸீனா

5.4 Name in Full (E) :-MUHAMMADHU ABBAS SITTHY FAZEENA

5.5 Permenent Address(S/T) :-போகஹபிடிய. பாணகமுவ. குருநாகல்.

5.6 Permenent Address(E) :-BOGAHAPITIYA. PANAGAMUWA.KURUNEGALA.

5.7.1 Admission Address (S/T) :-போகஹபிடிய. பாணகமுவ. குருநாகல்.

5.7.2 Admission Address (E) :-BOGAHAPITIYA. PANAGAMUWA.KURUNEGALA.

5.8 Contact Number :-..

5.9 WhatssApp Number :-0702001295

5.10 Email Address :-fazeenaabbas4@gmail.com

5.12 National ID Number :-877250318v

5.13 Date of Birth :-1987-08-12 Age-->:-36 Years , 3 Months , 3 Days

5.14 Gender :-Female

5.15 Civil Status :-Married

5.16 Degree :-BA SPECIAL DEGREE

5.17 University :-University of colombo

 06. Details on Payment of Examination Fees :-

6.1 Payment DS Division :-Rideegama

6.2 Payment Recipt Number :-913975

6.3 Date of Payment :-2023-11-14

Paste the Receipt here firmly.(Please keep a copy of the Receipt)

07. Declaration of the Applicant :-

A ) I certify that I have paid the examination fees to the relevant Divisional Secretariat and pasted the receipt in this
application. Also, I will abide by the rules imposed by Commissioner General of Examinations / North Western Provincial
Council Public Service Commission with regard to this examination.

(B) I do hereby declare that the particulars furnished by me in this application are true and accurate to the best of my
knowledge and belief and I have completed all parts of this application accurately and no information mentioned here
will be changed later. I agree to bear the consequences of not filling this application accurately or filling this application
incompletely.

( B) I know that if this statement made by me is found to be false, I will be disqualified before being appointed. I also
understand that if I am found ineligible for this post after being selected, I will be subject to dismissal.

…………………………………………………………………………………………………………

Signature of the Applicant

08. Attestation of the Signature of the Applicant :-

I do hereby certify that the applicant

Mr./Mrs./Miss………………………………………………………………………………………………………………………………………is known to me personally;
and he / she placed his / her signature before me on …………………………………………………………………………………………………………… and
he / she has paid the examination fees and pasted the receipt in this application

………………………………………………………………………………………………………………………………………
Signature and Official Seal of the Attester (Pl. confirm with clear the official seal)

09. Certification of the Head of Department, if the applicant is a public servant :-

I do hereby submit the application form of

Mr./Mrs./Miss……………………………………………………………………………………………………………………………………… I certify that he/she is
employed as a permanent/temporary/casual employee in this Ministry/ Department and if he/she is selected for this
post he/she may/may not be released from service

………………………………………………………………………………………………………………………………………
Signature and Official Seal of the Attester (Pl. confirm with clear the official seal)