Course applying for : *Year applying for : *PART A: PERSONAL INFORMATIONPrefixMr.Mrs.Ms.MissDr.Prof.First Name *Last Name *Passport / NIC Number : *0 / 12Passport / NIC *Choose FileNo file chosenDelete uploaded filePlease upload the Passport / NIC Date of Birth *MonthSelect month123456789101112DaySelect day12345678910111213141516171819202122232425262728293031YearSelect Year212021192118211721162115211421132112211121102109210821072106210521042103210221012100209920982097209620952094209320922091209020892088208720862085208420832082208120802079207820772076207520742073207220712070206920682067206620652064206320622061206020592058205720562055205420532052205120502049204820472046204520442043204220412040203920382037203620352034203320322031203020292028202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Age : *0 / 2Copy of the Birth Certificate *Choose FileNo file chosenDelete uploaded filePlease upload the Birth CertificateCivil Status : *SingleMarriedStreet Address : *City :State/Province :ZIP / Postal Code :Residence Phone Number : *Mobile Phone Number : *Email Address : *Employment Details *StudentEmployerPART B: EMPLOYMENT DETAILSDesignation :Official AddressTelephone Number :Official Email Address :Employment Letter / Service LetterChoose FileNo file chosenDelete uploaded filePlease upload the Employment Letter / Service LetterACADEMIC QUALIFICATIONSchool Attended : *G.C.E. Advanced Level *Choose FileNo file chosenDelete uploaded fileG.C.E. Ordinary Level *Choose FileNo file chosenDelete uploaded fileHigher Education / Professional QualificationsChoose FileNo file chosenDelete uploaded filePlease upload the Higher Education / Professional Qualifications DocumentsPERSON TO BE CONTACTED IN A CASE OF EMERGENCYPrefixMr.Mrs.Ms.MissDr.Prof.First Name *Last Name *Relationship to Student : *Telephone Number *AWARENESS ON IIHS PROGRAMMESHow did you get to know about our Programmes? (Select from the followings) *(Agent, Advertising Boards at IIHS, Brochures, Banners/Posters, Education Fair/Exhibition, E-mail, E-adds, Google, IIHS Student, IIHS Website, News paper advertisements, Radio, TV programmes/Commercials, Others)If others, please specify *Submit