All Ceylon Human Rights Federation

NAME IN FULL :

PERMANENT ADDRESS :

MOBILE NUMBER :

TELEPHONE NUMBER :

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DATE OF BIRTH :

AGE :

NATIONAL I.D. NUMBER :

RELIGION :

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GRAMASEWA DIVISION :

DIVISIONAL SECRETARIATE :

PRADESHIYASABHA DIVISION :

PROVINCIAL COUNCIL :

ELECTORATE :

POLICE AREA :

SCHOOLS ATTENDED :

EDUCATIONAL QUALIFICATIONS :

HAVE YOU BEEN CONVICTED FOR ANY OFFENCE?

DIFFERENT PORTFOLLIOS HELD IN SERVICE ORGANIZATIONS, IF ANY :

BUSINESSMAN, (NAME OF THE ENTERPRISE AND POSITION HELD) :

I HEREBY DECLARE THAT THE FACTS GIVEN HERE ARE TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE. I FURTHER DECLARE THAT I AM NOT HOLDING A MEMBERSHIP OF ANY OTHER HUMAN RIGHTS ORGANIZATION. :

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