DEPARTMENT OF EXAMINATIONS, SRI LANKA

EXAMINATIONS IN WESTERN MUSIC

THEORY EXAMINATION  …………………………………………  200….. 

ENTRY FORM

This form must be completed legibly and forwarded to the Commissioner General of Examinations, P.O. Box 1503, Colombo. by Registered Post. The name of the Examination should be written on the top left hand corner of the envelop. These Examinations will be held in Colombo, Galle, Kandy, and Kurunegala.

Any centre which does not have a sufficient number of candidates will be cancelled and the respective candidates will be assigned to the centre indicated as their Second Choice.

CENTRE SELECTED

First Choice : ……………………………       Second Choice : …….……………………  
1.      (i)  Name with Initials :
Master/Mr./Miss./Mrs. ………………………………………………
( In block Capitals: This name must be used at all stages of the Examination )
   
 (ii)  Name denoted by initials: ……………………………………
 ( In block Capitals) 
…………………………………………………………….......... 

Index Number

( for Office use only)
2.         Address ( Private ) :                                                                  Tel. No.
3.         Address ( School )

GRADE 

 DIPLOMA
4.         Grade/Diploma applied :

 PIANO

VIOLIN

 CELLO
5.         Aspect to be examined:     

(1) (2) (3)
Date Month Year
6.         Date of Birth :

7.        Fees Paid :                       Rs            8.Sex     
  1. I certify that the information given in this form is correct. I do hereby agree to be bound by the Regulations of this examination and the Rules for the Candidate issued by the Commissioner General of Examinations. I also certify that the stamps affixed by me above are genuine and not used before.
         Date : ………………………                                                           ………………………………..
                                                                                                                         Signature of Candidate
10. Attestation of Identity.
        
I certify the above named candidate who is personally known to me placed his/her signature in my presence today.
 
 
………………………………                                                            ……………………………
     Signature of Candidate                                                                      Signature of Attestor
 
 
            Name of  Attestor : ……………………………………………………………………………….
 
            Designation / Status : ……………………………………………………………………………...
 
            Address : ………………………………………………….
                       
                              …………………………………………………
The attestation required on this form should be made by a Justice of the Peace, Commissioner of Oaths, Attorney at Law or Notary Public, or a permanent Government Officer in receipt of an annual consolidated salary of Rs. 790,80 /- or over , Head of Government / Director Managed / approved School or the incumbent of a place of worship or a religious dignitary of standing or the Grama Niladari of the Division or a Principal of a private Music School presenting candidates for this examination.
CAGE FOR STAMPS
 
Grade  I           - Rs. 100/-                               Grade  VI        - Rs. 225/-                  
Grade  II          - Rs. 125/-                               Grade  VII       - Rs. 250/-                  
Grade  III        - Rs. 150/-                               Grade  VIII      - Rs. 275/-
Grade  IV        - Rs. 175/-                               Diploma           - Rs. 325/-
Grade  V         - Rs. 200/-
 
Candidate should affix stamps to the correct value and cancel them by placing his/her signature on them. Stamps should not over lap when pasted.
.