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Personal Information:
Name
* N.I.C No *
Father's Name
* N.I.C No *
Guardian's Name
* N.I.C No *
Gender
       
  Male Female Martial Status
Domicile
       
Province
* District *
         Date of Birth (*)
 Place of Birth (*)
Nationality1 (*)
          Nationality2
     
 
Current Address of Applicant (*)
 
Tel (Res) (*)                                                                                     Mobile Phone (*)
   
Permanent Address (tick if same as above)
Permanent Address of Applicant (*)
 
 Tel (Res) (*)                                                                                         Mobile Phone (*)
   
Email Address (*)
       
Father's/Guardian's Information
       
Father's/Guardian's Occupation
Father's/Guardian's Business Address
Tel (Office)
 
Mobile No
 
Email Address
Applicant's Information
       
Applicant's Designation (if employed)
Name of the Organization
Disability (if any)
 
Special arrangements required for the admission test and to attend classes at the campus
Emergency Case Information:
Name
Relationship with the Applicant
Telephone No(s)
Mobile No.
Address
User Information:
User ID *
Password *