Application: Student Membership

Personal Information

Full Name *

NIC / Passport No *

Scanned copy of NIC / Passport *

Click or drag a file to this area to upload.

Residential Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Address - Work

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Email *

Phone Home

Phone Mobile *

Photograph *

Click or drag a file to this area to upload.

Standard guidelines for the passport photographs are applied. Maximum file size - 2MB

Educational Qualifications

Academic Programme Enrolled in *

As it is defined in the Membership Criteria

Effective Date of the Qualification *

List of other educational qualifications

Supportive Documents *

Click or drag a file to this area to upload.

Academic Programme Enrolment proof is mandatory and You can provide other educational qualifications supportive documents as well. A certified copy will be needed to be submitted later.

1st Proposer Details

Name *

Membership No *

Email Address *

Phone Mobile *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Declaration *

Click or drag a file to this area to upload.

Scan copy of duly signed declaration form in the given format.

2nd Proposer Details

Name *

Membership No *

Email Address *

Phone Mobile *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Declaration *

Click or drag a file to this area to upload.

Processing Fee

A processing fee of Rs. 500.00 is charged for each submission of the application. The payment should be credited to the following account. Bank of Ceylon, Hyde Park Branch. Account Number 0002327056.

Scanned copy of Bank Deposit Slip / Online Payment References *

Click or drag a file to this area to upload.

Declaration *

Agree
Disagree

I hereby certify that all information furnished by me in this application are true and accurate to the best of my knowledge. I understand that providing any false information is leading to the rejection of the application. I also understand that if any or part of the information provided herein will be found false at a subsequent stage, such may cause the cancellation of the relevant Membership offered to me. I hereby abide by the governing rules and regulations of the institute and admit that the decision of the Executive Council, without any prejudice, related to this application is final.