Gazette No. 2504 - PDF page 30

Extracted page text

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PART  I :  SEC.  (IIA) – GAZETTE OF THE DEMOCRATIC SOCIALIST REPUBLIC OF SRI LANKA –28.08.2026
3012
09. Residence :  
	
i)	 Grama Niladhari division …………………… number 
	
ii)	 Divisional Secretariat …………………………….
	
iii)	 District ……………………………………….
10. Date Of Birth :     Year :                                            Month :                                  Date :
      Age as at 28.09.2026 :
  	
	
       Years :                                            Months :                                Days :
11.	Institution/ Department currently employed : …………………..
12.	Educational Qualifications- G.C.E (O/L)- First sitting
                i) Index No:-………………….. Year:-…………………………
Serial 
No. 
Subject
Pass
i)
ii)
iii)
iv)
v)
vi)
vii)
viii)
ix)
x)
               
 ii) G.C.E (O/L)- second sitting
 Index No:-…………………	
Year:-…………………….
      
Serial 
No. 
Subject
Pass
i)
ii)
iii)
iv)
v)
vi)
vii)
viii)
ix)
x)
 
13.	 Have you ever been convicted by a court of law for any offense?
Yes                         No  
(Mark an "X" in the relevant box.)