QR Code mqoa.,hka ,shdmosxÑ lsÍfï fomd¾;fïka;=j wd …

1 B,a m; fkd ,fha ksl=;a flf mq',s'fo' '1"7"8 >7>8 / DRP 1,7, 8. tpz;zg;gg;gbtk; fl;lzkpd;wp toq;fg;gLfpwJ wkqms<sfj, wxlh Application form is issued free of charge njhlh; ,y. Serial No QR Code mqoa .,hka , shdmosx ls f fomd ;f ka;=j "wd" wdlD;sh 1968 wxl 32 ork mqoa .,hka , shdmosx ls f mkf;a 9"16 iy 17 jk ;s hgf;a ye kq m;%hla i|yd b,a m;%h Ml;fisg; gjpT nra;Ak; jpizf;fsk;. gbtk; M . 1968 Mk; Mz;bd; 32 Mk; ,yf;f Ml;fisg; gjpT nra;jy; rl;lj;jpd; 9>16 kw;Wk; 17 vd;Dk; gphpTfspd; fPo; milahs ml;ilnahd;Wf;fhd tpz;zg;gk;. Department for Registration of Persons Form "B . Application for an Identity card under sections 9,16 and 17 of the Registration of Persons Act, No 32 of 1968. osia;%slalh m%d'f,a' fld Gdih .%d'ks wxlh yd fld Gdih khtl;lk; gp. nr. gphpT fp. Nr. ,yf;fKk; gphpTk; PdhdrEmh District Division Number and Division fuys w,jkak Gifg;glj;ij ,q;Nf xl;lTk.

2 Ld hd,Sh m%fhdackh i|yd /mYtyfg; ghtidf;F / FOR OFFICE USE Af x Photograph Here IDENTITY CARD NO. REGISTRATION OFFICER'S. CODE & INITIALS. fuu b,a m; Wmfoia m;%sldfjys we;s Wmfoia wkqj i mQ K l< hq;= h tpz;zg;gg;gbtkhdJ mwpTWj;jy; ifE}ypy; mlq;fpAs;s mwpTWj;jy;fSf;fpzq;f epug;gg;gLjy; Ntz;Lk;. Application form should be completed according to the instructions contained in the instructions manual. m<uqjk fldgi - b,a lre iska i mQ K l< hq;= h / ghfk; xd;W - tpz;zg;gjhuhpdhy; G+uzg;gLj;jg;gl Ntz;Lk;/. Part One - To be filled by the Applicant i mQ K ku ^isxyf,kaa fyda fouf<ka ngaH (rpq;fsk; my;yJ jkpopy;)$ Name in Full (in Sinhala or Tamil). 1 fm<m;a kduh/. FLk;gg; ngah;/. Family Name ku/ngah;/Name ;ijapd; ngah;/Surname i mQ K ku ^ lemsg,a wl= ka ngah; (Mq;fpy nghpa vOj;Jf;fspy;) /Name in Full (English Block Letters).

3 2 fm<m;a kduh/. FLk;gg; ngah;/. Family Name ku/ngah;/Name ;ijapd; ngah;/Surname ye kq mf;ys i|yka h hq;= ku ^ ku 1 fldgqfjys kug jvd fjkia jkafka k & $ milahs ml;ilapy; Njhd;w Ntz;ba ngah;. (1k; $l;bYs;s ngahpypUe;J NtWgl;bUg;gpd;) / Name to be appeared in the Identity Card (If the name is different to the name in cage 1). 3 fm<m;a kduh/. FLk;gg; ngah;/. Family Name ku/ngah;/Name ;ijapd; ngah;/Surname 1. 4' ia;%S$mqreI Ndjh/ghy;/Sex : ia;%S$ngz;/Female mqreI$Mz;/Male 5. is ,a ;;ajh ( jdyl/ w jdyl/ jekaoUq/ oslalido /. Fbapay; me;j];J jpUkzkhdth;/ jpUkzkhfhjth;/ tpjit/ tpthfuj;J/. Civil Status Married Single Widowed Divorced 6. jD;a;sh$/lshdj$;k;=r/. cau; njhopy;/ njhopy;/ gjtpg; ngah;/. Profession/Occupation/Designation (. 7' Wm; ms,sn| ia;r /gpwg;G tpguq;fs; /Details of Birth : 7'1 Wmka kh/gpwe;j jpfjp/Date of Birth 7'2 Wmamekak iy;slfha wxlh$gpwg;G rhd;wpjo; ,yf;fk;$Birth Certificate No Y Y Y Y M M D D.))

4 7'3 Wmka ia:dkh/gpwe;j ,lk;/Place of Birth 7'4 fld Gdih/gphpT/Division 7'5 ia;%slalh/khtl;lk;/District wh lre Y%S ,xldfjka msg; Wmka ;eke;a;l= k 1948 wxl 18 orK mqrjeis mkf;a 5^2 sh hgf;a ksl=;a lrk ,o mqrjeis iy;slfha f;dr;=re / tpz;zg;gjhuh; ,yq;iff;F ntspNa gpwe;jpUg;gpd;> 1948 Mk; Mz;bd; 18 Mk; ,yf;f> gpurhThpikr; rl;lj;jpd; gphpT 5(2) ,d; fPo;. toq;fg;gl;l gpurhThpikr; rhd;wpjopd; tpguq;fs;/If the applicant is born outside of Sri Lanka, details of Citizenship Certificate issued under Section 5(2) of the Citizenship Act, of 1948. 7'6 Wmka rg/gpwe;j ehL/Country of Birth 7'7 ;/City 7'8 iy;slfha wxlh/rhd;wpjopd; ,yf;fk;/Certificate No. 8' m x h ms<sn| ia;r / tjptpl tpguq;fs; / Details of Residence ia r ,smskh /epue;ju Kfthp / Permanent Address ksjfia ku fyda wxlh/tPl;bd; ngah;. my;yJ ,yf;fk;/Name or number of the House iyd m;Hfha$ksjdifha$ksjdi fhdackd l%ufha$.

5 Kjd;efka fyda fjk;a mosx ia:dkfha ku $l;lhl;rpahjdj;jpd;> mLf;F tPl;bd;>. tPlikg;Gj; jpl;lj;jpd;> Fbkidapd;>. Njhl;lj;jpd; my;yJ NtNwNjDk;. fl;blj;jpd; ngah;. Name of Condominium, flat, scheme, quarters, estate or any other buildings mdr$ h/mgqu.$fmfoi$WoHdkh/. tPjp/njU/xOq;if/,lk;/Njhl;lk;/. Road/Street/Lane/Place/Garden .u$ ;/efuk;/Village/City ;eme,a fla;h/mQ;rw;FwpaPL/Postal Code ;eme,a ,smskh /mQ;ry; Kfthp/Postal Address ksjfia ku fyda wxlh/tPl;bd; ngah;. my;yJ ,yf;fk;/Name or number of the House iyd m;Hfha$ksjdifha$ksjdi fhdackd l%ufha$. kjd;efka fyda fjk;a mosx ia:dkfha ku $l;lhl;rpahjdj;jpd;> mLf;F tPl;bd;>. tPlikg;Gj; jpl;lj;jpd;> Fbkidapd;>. Njhl;lj;jpd; my;yJ NtNwNjDk;. fl;blj;jpd; ngah;. Name of Condominium, flat, scheme, quarters, estate or any other buildings mdr$ h/mgqu.$fmfoi$WoHdkh/. tPjp/njU/xOq;if/,lk;/Njhl;lk;/.

6 Road/Street/Lane/Place/Garden .u$ ;/efuk;/Village/City ;eme,a fla;h/mQ;rw;FwpaPL/Postal Code 2. 9' mqrjeis iy;slh $ oa ;aj mqrjeis iy;slh ms<sn| ia;r ^wod< fkdjk fldgi lmd y kak&. gpurhTupikr; rhd;wpjo;/,ul;il gpurhTupikr; rhd;wpjo; njhlHghd tpguq;fs; (nghUj;jkw;wij fPwptpLf.). Details of Citizenship Certificate /Dual Citizenship Certificate (strike off which ever is inapplicable). 9'1 iy;slfha wxlh /rhd;wpjopd; ,yf;fk;/Certificate Number 9'2 iy;slh ksl=;a l< oskh /rhd;wpjo; tpepNahfpf;fg;gl;l jpfjp/ Date of issue of Certificate Y Y Y Y M M D D. ye kq mf;ys fojk msgm;la b,a lrkafka k lreKdlr 10 jk fldgi i mQ K lrkak milahs ml;ilapd; ,izg;gpujpf;fhf tpz;zg;gpf;fg;gbd; jaT nra;J $L ,yf;fk; 10,id epug;gTk;. If the duplicate of the Identity Card is applied for, please complete cage 10'^wod, fldgqj bos fhka ,l=K fhdokak& / ,iaghd $l;by; vd milahsk; ,lTk; /.

7 Purpose of application (Mark in the relevant cage). 10'1 ye kq m; ke;sjQfha k ta i|yd 10'2 ye kq m; ixfYdaOkh ls u i|yd milahs ml;il fhzhky; NghapUg;gpd; milahs ml;ilapy; jpUj;jq;fis nra;tjw;F. if the Identity Card is lost to make changes to the Identity Card 10'3 j, ld,h w ;a ls u i|yd 10'4 ye kq m; ydks u$m u$wmeyeos,s u i|yd nry;YgbahFk; fhyg;gFjpia GJg;gpg;gjw;F milahs ml;il Nrjg;gLj;jg;gbd;/cUtopf;fg;gbd;/thrpf;fK bahjpUg;gpd;. to renew the period of validity if the Identity card is damaged/ defaced /illegible 10'5' ke;sjQ fyda wjika jrg ,nd .;a ye kq mf;a wxlh fhzhky; Nghd / ,Wjpahfg; ngw;Wf; nfhz;l milahs ml;il ,yf;fk;. Lost or last obtained Identity Card Number 10'6' ye kq m; ksl=;a l< oskh /milahs ml;il tpepNahfpj;j jpfjp / Y Y Y Y M M D D. Date of the issue of the Identity Card 10'7' ke;sjQ ye kq m;la i|yd fmd,sia jd ;dj fyda wod< fjk;a ,shlsh ,s ms<sn| ia;r fhzhkw; Nghd milahs ml;il njhlh;ghd nghyp]; mwpf;ifapd; my;yJ NtW Mtzj;jpd; tpguq;fs.

8 Details of the police report or other document pertaining to the lost Identity Card fmd,sia ia:dkfha ku $. nghyp]; epiyaj;jpd; ngah; /. Name of the Police Station fmd,sia iy;slh ksl=;a l< oskh $nghyp]; mwpf;if toq;fg;gl;l jpfjp$ Y Y Y Y M M D D. Date of the issue of the Police report 11' uiS i|yd wjYH f;dr;=re/ tprhuizfSf;fhf Njitg;gLj;jg;gLk; tpguq;fs; /Details required for inquiries : 11'1 rl:k wxlh ksji/tjptplk;;/Residence ;fj; njhiyNgrp /Mobile njhiyNgrp ,yf;fk;. Telephone No 11'2 oHq;a ;emE, kpd;dQ;ry;. E-mail m f,dalkh ls f PdhdrEmh PdhdrEmh fuys w,jkak fuys w,jkak Gifg;glj;ij ,q;F ,q;Nf xl;lTk;. epoYUntLj;jYf;f Af x hd Gifg;glj;ij the Photograph xl;lTk;. Here Af x the Photograph iy;sl ls f ks, w;aik iy for scanning ks, uq dj here rhd;Wg;gLj;Jk; mYtyhpd;. ifnahg;gKk; gjtp Kj;jpiuAk;. Signature and of cial frank of the certifying of cer b,a m%ldYh 1' uu Y%S ,xldf mqrjeishl= nj m%ldY lr '.

9 2' uu fuu b,a m; i mQ K ls ug fmr f iu we;s Wmfoia m;%sldj lshjd f;are .;a nj m%ldY lr '. 3' uu PdhdrEm folla fuys we;=<;a lr '. 4' uu f iu wxl '''''''''''''''''''''''''''''''''ork ye kq m;$ke;sjQ wxl '''''''''''''''''''''''''''''''''' ork ye kq m; fjkqfjka ,nd .;a fmd,sia jd ;dj iy;sl ls f ks,Orhd fj; Ndr fo ' ^wod, fkdjk fldgi lmd y kak&. 5' ka fmr ud iska fjk;a b,a m;%hla bos m;a lrk ,o $ fkdlrk ,o nj uu m%ldY lr ' ^wod, fkdjk fldgi lmd y kak&. 6' fuys by; oelafjk ia;r ud fyd|ska okakd m os yd Yajdi lrk wkaoug i;H yd ksjeros nj uu fuhska m%ldY lr '. 7' f b,a m;%h iu bos m;a lrkq ,nk ish u ,shlsh ,s ud fyd|ska okakd m os yd Yajdi lrk wkaoug i;H yd ksjeros nj;a" i;H. f;dr;=re jika ls u i|yd tlS ,shlsh ,s jHdc f,i fjkia ls j,g fyda tl;= ls j,g Ndckh fkdlrk ,o nj;a mqoa .,hka , shdmosx . ls f mk; hgf;a , shdmosx y m;%hla $ y m;%fha fojk msgm;la b,a ls ug ys l we;s nj;a ^wod, fkdjk fldgi lmd y kak& uu fuhska iy;sl lr m%ldY lr is ' ;j o wi;H o;a;" f;dr;=re fyda ,sh ,s bos m;a ls u o`vqj ,e h yels jrola nj uu oks ''.

10 3. tpz;zg;gjhuhpd; ntspg;gLj;Jif 1. ehd; ,yq;ifg; gpuirahfTs;Nsd; vd ntspg;gLj;Jfpd;Nwd;. 2. ehd; ,t;tpz;zg;gg;gbtj;ij epug;G Kd;dh; ,jNdhL ,izf;fg;gLs;s mwpTWj;jy;fs; ifE}iy thrpj;J tpsq;fpf; nfhz;Nld; vd ntspg;gLj;Jfpd;Nwd;. 3. ehd; vdJ epow;glq;fspd; ,uz;L gpujpfis cs;slf;Ffpd;Nwd;. 4. ehd; .. Mk; ,yf;fj;jpidf; nfhz;l milahs ml;ilia / Mk; ,yf;fj;jpidf;. nfhz;l njhiye;j milahs ml;il ,yf;fj;jpw;Fg; gjpyhf ngw;Wf; nfhz;l nghyp]; mwpf;ifia rhd;Wg;gLj;Jk; mYtyhpw;F. ,j;jhy; rkh;g;gpf;fpd;Nwd;. 5. ehd; ,t;tpz;zg;gj;jpw;F Kd;dh; NtW VNjDk; tpz;zg;gj;ij nra;jpUf;fpNwd;/ nra;atpy;iy vd ntspg;gLj;Jfpd;Nwd;. (nghUj;jkw;wij fPwptpLf.). 6. NkNy nfhLf;fg;gl;l tpguq;fs; vdJ mwpTf;Fk; ek;gpf;iff;Fk; vl;ba tiu cz;ikahditAk; nrk;ikahditAk; vd ehd; ,j;jhy;. ntspg;gLj;Jfpd;Nwd;. 7. ,t;tpz;zg;gg;gbtj;Jld; Nrh;j;J nfhLj;Jjtg;gl;l vy;yh Mtzq;fSk; vdJ vdJ mwpTf;Fk; ek;gpf;iff;Fk; vl;ba tiu cz;ikahditAk; nrk;ikahditAk; vd;Wk; mj;Jld; cz;ikahd tpguq;fis kiwf;Fk; nghUl;L mit Nghypahfg.