Application: Part III Guide Course 2022

Details of the Candidate

Name in full as appear in NIC or Passport : *

(in block letters)

Name with initials: *

NIC Number *

Permanent Address: *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Email *

Phone (Mobile) *

Registration Details

Associate Membership Number *

Eg-: P3/202*-**/**

Enrollment *

For 2nd or 3rd attempt (referred candidates) please list down the modules registered for

Payment

Multiple Choice *

Full Payment (Rs.70,000)
Three Installments (Rs.25,000, Rs.20,000, Rs.20,000)
Module based payment #

# only for the referred candidates.

Payment Receipt

Click or drag a file to this area to upload.

Payments shall be made to Account No. 0002350014 of Bank of Ceylon, Hyde Park in favour of the Institute of Town Planners Sri Lanka. or shall be transferred to the same account through online banking.

Declaration *

I hereby declare that the details and information given above are complete and true to the best of my knowledge