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  Diploma in Gemmology (DGem) Gemmologists Association of Sri Lanka (GASL)
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APPLICATION FORM
DIPLOMA EXAMINATION IN GEMMOLOGY
GEMMOLOGISTS ASSOCIATION OF SRI LANKA
(PLEASE WRITE IN BLOCK CAPITALS)
NAME WITH INITIALS:  Rev./Prof./Dr./Mr./Mrs./Miss……………………………………………………

Full Name ………………………………………………………………………………….

DATE OF BIRTH: ……………YEAR………………MONTH………..  DATE  

NIC NUMBER:……………………………..

OCCUPATION:……………………………

ADDRESS :………………………………………………………………………………
………………………………………………………………………………………………

TEL: ………………………                            MOBILE:………….………………..
EMAIL:………………………..                     WEBSITE: ………………….…….…                                               
EDUCATIONAL QUALIFICATIONS (certified copies attached)                                                               
 ……………………………………………………………...            
……………………………………………………………….             ………………………………………………………………              
          
PROFESSIONAL MEMBERSHIPS ……………………………………………………… 

Mode of payment cash recipt no /nank ref no ………

Above information are true & correct according to my knowledge

………………..                                                          …………………………
Date                                                                             Signature of applicant


  Jewels 2009
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