Registration Form - Faculty of Engineering

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Title :*
Name in Full :*
Faculty :*
Course Name :*
Full-time / Part-time :*
Date of Birth :*	DD: MM: YYYY:
Nationality :*
Postal Address :*

Permanent Address :*

NIC / Passport Number :*
Home Phone Number :*
Mobile Phone Number :*
E-mail Address :*
School Attended :

G. C. E. A/L Results :*	Year : Local Examination Foreign Examination
	Z-Score :
	Subject	Grade




Upload your A/L Results Sheet :*

Person to be contacted in case of emergency :*	Name : Telephone Number :

Whom did you contact? (name of the marketing executive) :*

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Course Fee Payment Method :*	Full Payment Installments
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