First Degree

University,of Moratuwa, Sri Lanka,- General Convocation - 2015

Supplication Form for First Degree
01

Name with Initials1 (English)

W.D.N.H.PERERA

02

Full Name in English

Miss. WANIGASURIYAGE DONA NILANGI HARSHANI PERERA

03

Name with initials (Sinhala/

Tamil)

. . . .

04

Full Name in Sinhala / Tamil

05

NIC No.,/ Pass Port No.

895870161V

06

Contact Address

NO.16/9, THOMAS LANE, COLOMBO 9

07

Year of Entry

2010

08

Name of the First Degree in

respect of which the
supplication is submitted.

B.Des (Hons)

09

Field of Specialization

Fashion and Lifestyle Design

10.(a) Department

11

12

Year of passing the rst Degree

with Registration No.

Dept.of Integrated
Design

Registration No.

10.(b)

102238D

Faculty Faculty of Architecture

Year

Registration No.

2015

102238D

Residence

Mobile

0112674630

0778816948

Oce

Tel. No

13

E-mail

nilangi_harshi@yahoo.com

14

State whether the Degree is to be awarded "in person" or "in absentia". (If you are
attending indicate as "in person" / if you are not attending indicate as "in absentia". In
In Person
the case of "in absentia" the degree will be conferred in the absence of the graduand
at the Convocation.)
I do solemnly declare that I will faithfully observe the Statutes, By-laws, Regulations and Rules of the University of
Moratuwa, Sri Lanka, so far as they may apply to me, and I will not make use of privileges that are to be conferred upon
me so as in any way to bring the institution to disrepute.
I certify that I have not been admitted to the above degree so far, and that the above facts are true and accurate to the
best of my knowledge.
June 23, 2015, 10:52 am
Date
1

........................................................
Signature of the Graduand

Please ensure that the name should be in conformity with the name given by you on admission to the University and
used thereafter during the course of study.

First Degree

Notes for the graduands

Registration and Certificate Fee
Graduands are required to submit a pay-in-voucher for Rs. 1250/= obtained from any Bank of Ceylon
Branch drawn in favor of "University of Moratuwa" (Account Number 306836) along with the
Supplication Form. Those who wish to make this payment at the Shroffs counter of this University may
do so from 9.00 a.m. - 12.30 p.m. and 1.30 p.m. - 3.00 p.m. on working days up to 30th June, 2015.

Office Use Only

All cages must be essentially filled.
1. The name mentioned in cage 2 is correct / not correct (if not mentioned correct name)
..............................................................................................
2. The details in cages 1,6,7,8,9 &10 are correct and the student is eligible for the conferment of
the Degree of: .........................................................................
Effective Date: ..............................
3. Senate approved the above results at its ................................. Meeting held on ........................
Subject Clerk:
SAR/Exams:

......................................
......................................

Entered in the Graduands List: ......................................

(Signature of Suject Clerk)

89629172

Date:

..............................

Date:

..............................

Date:

..............................