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;. ld hd,Sh m%fhdackh i|yd /mYtyfg; ghtidf;F / FOR OFFICE USE Af x Photograph Here IDENTITY CARD NO. REGISTRATION OFFICER'S.

2 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). 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 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. 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.))

4 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$. 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;>.

5 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 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; /.

6 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;. Details of the police report or other document pertaining to the lost Identity Card fmd,sia ia:dkfha ku $.

7 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 '. 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.

8 ;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 ''. 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.

9 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;. Gidag;gltpy;iy my;yJ khw;wq;fSf;F cw;gltpy;iy vd;Wk; ehd; ,j;jhy; rhd;Wg;gLj;Jfpd;Nwd;. mj;Jld; 1968Mk; Mz;bd; 32Mk;. ,yf;f Ml;fisg; gjpT nra;jy; rl;lj;jpd; Vw;ghLfspd; fPohd gjptpd;; kPJ milahs ml;ilf;F / ,izg;gpujp ml;il xd;Wf;fhf tpz;zg;gpf;fj; jifik cilatdhNtd.

10 Gpioahd tpguq;fs;> jfty;fs; my;yJ Mtzq;fisf; nfhLj;JjTjy;. jz;bf;fg;glw;ghyjhd jtnwhd;whFk; vd;w epfo;it ehd; mwpNtd;. Declaration of the Applicant 1. I declare that I am a citizen of Sri Lanka ;. 2. I declare that I have read and understood the instructions manual attached here to before completing this application form ;. 3. I enclose two copies of my photographs ;. 4. I hereby hand over the Identity Card bearing number /Police report obtained in lieu of the lost Identity Card bearing number [Strike off whichever is inapplicable] to the certifying of cer.;. 5. I declare that I have/have not made any other application previous to this application ; (strike off whichever is inapplicable). 6. I hereby declare that the particulars given above are true and accurate to the best of my knowledge and belief ;. 7. I do hereby certify that all the documents furnished along with this application form are true and accurate to the best of my knowledge and belief and they have not being subjected to forgery or alterations in order to conceal true details and also I am eligible to apply for and identity card/ duplicate card upon registration under the provision of Registration of Persons Act.