DEPARTMENT OF EXAMINATIONS, SRI LANKA General Certificate ...

Specimen Application FormGENERAL CERTIFICATE OF EDUCATION (ORDINARY LEVEL) EXAMINATIONDECEMBER 2011FOR OFFICE USE ONLY01. Town selected and Town NumberTown: …………………………………………Town Number:(Private Candidates should select the town close to their permanent residence to sit this examination).02. Full name:I. (In Block Letters in English) ) (See No.2 of the Instructions Schedule)II. In Sinhala …………………………………………………………………………………………….………………………………………………………………………………………………………..03 Address: (In Block Letters)……………………………………………………………………..……….……………………………………………………………………………………………………………04. Sex Male 0 Female 105. Date of Birth :Year ……………………………. Month ………………………. Date ……………………06. National Identity Card No.07. Telephone No.08. Language Medium:Sinhala 2 Tamil 3 English 409. Examination Fees paidin Figures Rs. …………………………in words Rs. ……………………………………(I) Receipt No. …………………….. (II) Date …………………………(III) Post Office/Sub Post-Office at which the fees were paid ………………………10. Total number of subjects applied:11. Subjects and Subject Numbers:Subjects Applied Subject No. Subject No.01. ………………………………. SUBJECTS IN GROUP I02. ………………………………. 07. ………………………………03. ………………………………. SUBJECTS IN GROUP II04. ………………………………. 08. ……………………………..05. ………………………………. SUBJECTS IN GROUP III06. ………………………………. 09. ………………………………12. Declaration by the Candidate: -