fiajd kshqla; hkaf.a Ndr wruqo ,a uKav,h CopaH ek;gpf;ifg; nghWg;G ...

ld¾hd,Sh m%fhdackh i`oyd muKhs
mYtyf cgNahfj;jpw;F kl;Lk;
For office use only
fiajd kshqla;hkaf.a Ndr wruqo,a uKav,h
CopaH ek;gpf;ifg; nghWg;G epjpar;rig
EMPLOYEES’ TRUST FUND BOARD
2012 j¾Ifha 5 jir YsIH;ajh iu;a fiajd kshqla;hkaf.a Ndr wruqof,a
idudcslhskaf.a ¥ mq;=kag remsh,a 15"000/- l ;s

^07&¡ ÿrl:k wxl/ njhiyNgrp ,yf;fk; /Telephone Number (-¡¡
ksji /tjptplk; / Residence(-…………………………..…………… ld¾hd,h/ mYtyfk; / Office (-…………………………………….…
cx.u/ ifalf;fj; njhiyNgrp / Mobile (-¡¡………………………………………….………
…………………………………………………¡ ………………………………………………………..………………….
oskh/jpfjp/ Date idudcsl;ajh orkakdf.a ^uj/ mshd/Ndrlre&¡ w;aik /
mq;fj;jthpd; ifnahg;gk; /Signature of Member
2 fldgi $ gFjp – 2 $PART (II) (-
YsIHhd$YsIHdj YsIH;aj úNd.hg fmkS isá mdif,a úÿy,am;s úiska iïmQ¾K l
Nkw;Fwpg;gpl;l tplaq;fs; rupahditnad;Wk; cWjpg;gLj;Jfpd;Nwd;. I certify that the above student passed the year 05
scholarship Examination in 2012 and that the information given above is correct.
úÿy,am;sf.a ÿrl:k wxlh/ghlrhiy mjpgupd; njhiyNgrp ,yf;fk; /Principal’s Telephone No(¡………………………..…………
oskh/jpfjp/ Date(-………………………………… ……………………………………………………………………….
úÿy,am;sf.a w;aik ^ks, uqødj ;nkak&
ghlrhiy mjpgupd; ifnahg;gk; (mYtyf ,yr;rid ,lTk;)
Signature of Principal [Please place official stamp]
3 fldgi $ gFjp – 3 $PART (III) (-
idudðlhd ^uj/ mshd/ Ndrlre& oekg fiajh lrk wdh;kfha m%Odkshd úiska iïmQ¾K l

ii¡ cd;sl ye÷kqïmf;ys ku/ Njrpa milahs ml;ilapYs;sthW ngaH /Name appearing in the National Identitycard:
(-………………………………………………………………………………………………………………………………………………………..……………...……
05¡ idudcslhdf.a cd;sl ye÷kqïm;a wxlh/ mq;fj;jtUila Njrpa
milahs ml;ilapd; ,yf;fk; /Member’s National Identity Card No
06¡ fiajhg ne|qKq oskh/ Nritapy; NrHe;j jpfjp /Date of joining (-
………………………………………………………………………
07¡ oekg orK ;k;=r/ njhopy; / gjtp /Nature of employment / position(- …………………………………………………………...……
08¡ i wdh;kfha fia'w'w' wxlh fyda mq'w'w' wxlh /CopaH Nrkyhg epjpak; my;yJ jdpahH Nrkyhg epjpa gjpT
j¾Ih
Mz;L
Year
,yf;fk;/ Employers EPF / PPF Registration Number (-…………………………………………
ii¡ idudcsl wxlh / mq;fj;Jt ,yf;fk; /Member Number (-…………………………………………
ii. YsIHhd / YsIHhdj 5 jir YsIHFj úNd.hg fmkS isá udihg fmr wdikak udi 13 odhl uqo,a mskhztpaH 5Mk; Mz;L Gyikg;guprpy guPl;irf;Fj; Njhw;wpa khjj;jpw;F Kd;duhd 13 khj cjTnjhif
njhlHgpyhd tpguq;fs;. / Details of contributions during the 13 months preceding the month in which the student sat
the year 05 scholarship Examination:
udih
khjk;
Month
2011 cQ,s / A+iy/ July
2011 wf.daia;= / Mf];l; /August
2011 iema;eïn¾/
nrg;nuk;gH/September
2011 Tlaf;dan¾ /Xf;NlhgH/October
2011 fkdjeïn¾/ etk;gH/November
2011 foieïn¾ /jpnrk;gH/December
tl;=j /nkhj;jk; /Total
2012 ckjdß/ rdtup/January
2012 fmnrjdß /ngg;utup/February
2012 ud¾;=/ khHr; / March
2012 wfm%a,a /Vg;gpuy; /April
2012 uehs /Nk /May
2012 cqks /A+d; /June
2012
tl;=j /nkhj;jk; /Total
cQ,s/ A+iy/July
wdh;kh úiska
fia'ks'Nd
wruqo,g fuu
idudðlhd
fjkqfjka f.jQ
odhl uqo,
contribution
paid to ETF on
behalf of the
member
epWtdj;jpduhy;
mq;fj;jtupw;fh
f C.e.ngh.ep
nrYj;jg;gl;l
cjTnjhif
wdh;kh úiska
fia'ks'Nd' wruqo,g
ish¿u fiajlhska
fjkqfjka f.jQ
odhl uqo,
contribution paid
to ETF on behalf of
all employees
epWtdj;jpdhy;
C.e.ngh.epjpaj;jp
w;F nrYj;jg;gl;l
KO cjTnjhif
(rfy CopaH
nghUl;Lk;)
fplam;a
wxlh
Cheque
No
fhNrhiy
,yf;fk;
odhl uqo,a
f.jk ,o
Èkh
Date -
contribution
paid
cjTnjhif
nrYj;jpa
jpfjp
odhl uqo,a
f.jk ,o
fmdaruh ^wd¾1
fyda wd¾4o
hkak&
Method of
payment (R1
or R4)
cjTnjhif
nrYj;jpa
gbtk;
(MH 1
my;yJ
MH 4)
2011¡07¡01 osk isg 2012¡08¡31 osk olajd by; i|yka fiajlhd fuu wdh;kfha fiajh lr we;s nj;a by; i|yka lr we;s odhl
uqo,a Tyq$weh fjkqfjka fia'ks'Nd' wruqo,g f.jd we;s nj;a iy;sl lrñ'
2011.07.01 Mk; jpfjpapypUe;J 2012.08.31 Mk; jpfjp tiu ,e;epWtdj;jpy; Nritahw;wpAs;shnudTk;> ,e;j
Copahpd;Nghpy; Nkw;Fwpg;gpl;l cjTnjhif C.e.ngh.ep rigf;Fr; nrYj;jg;gl;Ls;sJ vdTk; cWjpg;gLj;Jfpd;Nwd;.
I certify that the above employee has been employed in this Company / Estate / Institution from 01.07.2011 till 31.08.2012 and
the above mentioned contributions have been paid to ETFB on behalf of this employee.
oskh /jpfjp/Date (- ………………………………………… ……………………………………………………………………….…………………
iy;sl lrk ks,Odrshdf.a w;aik iy ;k;=r ^ks,uqødj&
cWjpg;gLj;Jk; mYtyupd; ifnahg;gKk; gjtpAk; (mYtyf ,yr;rid ,lTk;)
Certifying Officer’s Signature & Designation (Please place Official Stamp)
3

Wmfoia (-
1. YsIHhd / YsIHdjf.a Wmamekak iy;slfha cdhd msgm;la úÿy,am;s úiska iy;sl lr bosrsm;a l

APPLICATION FOR A SCHOLARSHIP OF RS.15,000/- TO THE CHILDREN OF ETF MEMBERS WHO HAVE PASSED THE YEAR 05
SCHOLARSHIP EXAMINATION - 2012
Instructions for Filling the Application
01. A photo-copy of the Birth Certificate of the student, certified by the school principal should be submitted.
02. If the student’s name appearing in the Results Schedule differs from the name appearing in the Birth Certificate,
please submit a letter certified by the school principal stating that both names refer to one and the same person.
03. If the member’s name appearing in the Birth Certificate of the student, name stated in the application by the employer and
member’s name appearing in Form II Returns differs, a letter certified by the Employer stating that all names refer to one and
the same person should be submitted.
04. A photo-copy of the National Identity Card of the Member, certified by the Employer should be submitted.
05. If the application is not made by either the father or mother of the student but by the guardian, he/she should furnish required
documents in proof legal guardianship.
06. If both parents are members of ETF , Only one should apply. A student is eligible to receive this Scholarship only once.
07. Only one application in respect of a student should be submitted. Please DO NOT submit more than one application.
08. At the time the student sat for the scholarship Examination (26 August 2012), the student’s mother, father or guardian should
have been an active member of the Fund.
09. The Employer should have paid contributions on behalf of the member for the 12 months preceding the month in which the
Examination was held. Form II Returns in respect of contributions remitted by the Employer should have been received by the
Board.
10. In instances where the member’s age is over 70 years, such member should have 25 years of active membership of the Fund and
should not have obtained a refund of contributions during that period.
11. Correctly completed applications should be sent before 07.12.2012 addressed to Scholarships Officer,
Employees’ Trust Fund Board, No. 92, Kirula Road, Narahenpita, Colombo 5. The top left hand corner of the
envelope should be marked “YEAR 05 SCHOLARSHIP 2012”.
12. Applications which are incomplete, illegible or containing erroneous information and received after the closing date will be
rejected.
13. Scholarship will be awarded only to 5,000 students who obtain high marks at the examination in each district wise. The decision
of the Board of Directors of ETF Board in selecting beneficiaries shall be final.
5