Ceylon Council of Optometry and Orthoptics

Ceylon Council of Optometry and Orthoptics Membership Application

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Vision Care Academy

College of Optometry and Vision Science

Ceylon Eye Care Optometric Association

Ophthalmic Technologists of Sri Lanka

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INSTRUCTION TO FILL THE APPLICATION

Ensure the photos are clear and of high quality.
Guarantor should be a member of Ceylon Council of Optometry & Orthoptics.
Kindly certify and upload the original documents.
Certificates should be certified by a JP or a Commissioner of Oaths as true copies.

1. Personal Information

Name with Initials : *
Name denoted by initials : *
Photograph: *
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Ensure the photograph is clear, focused, with a neutral expression, showing the face, head, and shoulders against a simple, light background and optimal lighting. NIC : *

NIC (Front Side) : *
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NIC ( Back Side ) : *
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Date of Birth : *

Gender : *

Nationality : *

Residential Address : *
Corresponding Address :
Office Address:

2. Contact Information

Mobile : *
Resident Phone :
Office Phone:
Email : *

3. Educational Qualification

Ordinary Level (O/L) : *

Year	Subject	Result

Advanced Level (A/L) : *

Year	Subject	Result

O/L Certificate : *
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A/L Certificate : *
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Academic Qualification:

Title of Examination	Institute or Centre	Month & Year

Academic Qualification Certificates
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Other Educational Qualification:

4. Working Experience & Qualification

Professional Qualification:
Service Letters
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Present Employment:

Position	Work place	Time period

Working Experience:

Location	Position	Time period

5. Guarantor Details

Guarantor Name : *
Guarantor Address : *

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