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Application For DC

The document is an application form for a diploma certificate that requires the student to provide personal details including their full name, gender, diploma type, and contact information. It also asks for confirmation of the accuracy of the information provided and requires a payment receipt for the certificate fee. Additionally, a copy of the detailed certificate must be attached unless the student has provincial results.

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kirushanthan nadeswaran
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411 views1 page

Application For DC

The document is an application form for a diploma certificate that requires the student to provide personal details including their full name, gender, diploma type, and contact information. It also asks for confirmation of the accuracy of the information provided and requires a payment receipt for the certificate fee. Additionally, a copy of the detailed certificate must be attached unless the student has provincial results.

Uploaded by

kirushanthan nadeswaran
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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DC - 1

APPLICATION FOR DIPLOMA CERTIFICATE


(This form should be completed by student)

1. Name in Full in English : ………………………………………....................................

………………………………………………………………………………………….
(Capitalized Each Word) This name is used for the Diploma Certificate. The
certificate will not be reissued if the name mentioned by the candidate in the cage 1 is
incorrect.

2. Name with Initials in English : …………………………………………………………

…………………………………………………………………….(Capitalized Each Word)

3. Male / Female : …………………………………………………………………………

4. Name of the Diploma to be conferred :


[HNDA/ HNDE (Civil) / HNDE (Mechanical) / HNDE (Electrical & Electronics) /
HNDBSE/ HND in English/ HNDPM/ HNDQS/ HNDM/ HNDIT/ HNDT (Agri)/ HNDBA/
HNDBF/HNDFT/ HNDTHM/ HNDCSPT]
5. Full Time / Part Time : ………………………………

6. Year of passing the Examination mentioned in the item 4 above : ……………………

7. Postal Address : ………………………………………………………………………...


…………………………………………………………………………………………..
8. E-mail Address : ……………………………………………..
9. Contact Telephone No : ……………………………………..
10. Student Registration No(s) : ………………………………
11. National Identity Card No : …………………………………….
12. Name of Advanced Technological Institute : …………………………………………..
13. Whether you have attached the receipt of the certificate fee of Rs. 6,400/= ……………
14. Please attach a copy of your detailed certificate to this application form. (Not required for
the students having provincial results).

I confirmed all above information are true and correct according to best of my knowledge
and I confirmed my name in section 1 which is used to issue the Diploma Certificate is
correct.
..…………………………..
Signature of the Applicant

Affix the bank SLIP which you paid to the Peoples Bank

Name of the Bank : People’s Bank

Branch : Hyde Park Corner Branch, Colombo 02

Account No : 025-1001-3-3397613

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