DEPARTMENT OF EXAMINATIONS, SRI LANKA THEORY EXAMINATION IN WESTERN MUSIC - 2013 GRADE I TO GRADE VIII & DIPLOMA Application forms for the above English medium Examination will be issued by post and to personal callers from 01st January 2013. Forms of application also can be downloaded from the Department website (www.doenets.lk). Application form could be obtained by post sending a self - addressed stamped (to the value of Rs.5.00) envelope of size 9”x4” to the under mentioned address before 24th January 2013. Address: Commissioner General of Examinations, Organization & foreign examinations Branch, Department of Examinations, Pelawatta, Battaramulla. Name of the examination should be written (Theory Examination in Western Music - 2013) on the top left hand corner of the envelope. Personal callers may obtain the application forms at the inquiries counter of the Department of Examinations, Pelawtta, Battaramulla up to 24th January 2013 and perfected applications must be sent by post. Closing date of application will be 01st February 2013. Telephone: 011 - 2785230 / 011 - 2177075 Fax : 011 - 2784232 W.M.N.J. Pushpakumara, Commissioner General of Examinations. 5/3/4/AD/2013 Organization & Foreign Examinations Brach, Department of Examinations, Pelawatta,Battaramulla. 26th December 2012.

‫‏‬ DEPARTMENT OF EXAMINATIONS, SRI LANKA THEORY EXAMINATIONS IN WESTERN MUSIC 2013 ENTRY FORM This form must be completed legibly and accurately and forwarded to the Commissioner General of Examinations, Organization & Foreign Examinations Branch, Department of Examinations, Pelawatte, Battaramulla by Registered post. The name of the Examination should be written on the top left hand corner of the envelope. These Examinations will be held in Colombo, Galle, Kandy, Badulla and Kurunegala. Any centre which does not have a sufficient number of candidates will be cancelled and the respective candidates will be directed to the centre of their Second Choice or to a suitable Centre. CENTRE SELECTED

2nd Choice: ………………………………………

1st 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) Names denoted by Initials: ……………………………………………………………………………………….. (in block Capitals)

2.

Permanent Address:…………………………………………………………………………………………………. (for dispatch of Admission Card)

Tele. No.:……………………

Address (School):……………………………………………………………………………………………………..

Day …….......

Month …….......

3.

Date of Birth:

5.

Grade / Diploma applied to be examined:

6.

Fees paid

Rs.

Year …….......

Post Office Date of Payment Receipt Number

4. Sex

Male / Female

:………………………… :………………………… :…………………………

CAGE FOR RECEIPT

GRADE I GRADE II GRADE III

- Rs. 400/- Rs. 400/- Rs. 400/-

GRADE IV GRADE V GRADE VI

– Rs. 400/– Rs. 600/– Rs. 600/-

GRADE VII - Rs. 600/GRADE VIII - Rs. 600/DIPLOMA - Rs. 750/-

Candidates should affix the receipt for examination fee paid at a post office. They are advised to keep a photocopy of the receipt with you.

7.

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 Candidates issued by the Commissioner General of Examinations.

8.

Attestation of Identity. I certify that the above named candidate who is personally known to me placed his / her signature in my presence today. ………………………………………. Signature of Candidate

……………………………………. Signature of Attestor Date ………………………….

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. 240 360/- or over, Head of a Government / Director Managed / approved School or the incumbent of a place of worship or a religious dignitary of standing or the Grama Niladhari of the Division, or a Principal of the private Music school presenting candidates for this examination.

E:\EXAM 02\Chinthaka 02\Western Music\2013\Theory Exam Paper Add & Application form.doc