PART A: APPLICATION FOR THE REGISTRATION IN THE ENGINEERING COUNCIL O

(ECSL) AS AN ENGINEERING DIPLOMATE

1 Expanded Full Name
2 Name With Intials
3.1 ECSL Practitioner Category
3.2 ECSL Registration Number
3.3 IIESL Membership Number
4.1 Main Engineering Discipline 1
4.2 Main Engineering Discipline 2 (if any)
4.3 Current Engineering Practice 1
4.4 Current Engineering Practice 2
4.5 Current Engineering Practice 3
5.1 Country of Nationality 1
5.2 Country of Nationality 2
6 NIC/Valid PP No
7 Date of Birth
8 Gender
9.1 Postal Address Number/House Name
9.2 Postal Address Street
9.3 Postal Address City
9.4 Postal Address State (foreign)
9.5 Postal Address Country
10.1 Permanent Address Number/House Name
10.2 Permanent Address Street
10.3 Permanent Address City
10.4 Permanent Address State (foreign)
10.5 Permanent Address Country
11.1 Mobile Number 1
11.2 Mobile Number 2
11.3 Fixed Telephone Number
12 E-mail address
13 Academic Qualifications
Signature of Applicant
 FORM NO : ECSL-REG-EngDip PART A

ISTRATION IN THE ENGINEERING COUNCIL OF SRI LANKA

AN ENGINEERING DIPLOMATE

Engineering Diplomate
Date