KYC — Individual / Joint

Primary Applicant

Full name as it appears in the NIC/Passport

NIC/Passport

Date of Birth

Citizenship: Sri Lankan Other

Residency Status: Resident Non-Resident

Permanent Address:

Correspondence address (if different from above):

Contact Details:

Home Landline / Mobile:

Work Landline / Mobile:

Email:

Joint Applicant

Full name as it appears in the NIC/Passport

NIC/Passport

Date of Birth

Citizenship: Sri Lankan Other

Residency Status: Resident Non-Resident

Permanent Address:

Correspondence address (if different from above):

Contact Details:

Home Landline / Mobile:

Work Landline / Mobile:

Email:

Primary Applicant

Designation / Profession

Name of Organizatione

Nature of Business

Business Address

Joint Applicant

Designation / Profession

Name of Organizatione

Nature of Business

Business Address

Primary Applicant

Are you, any immediate family member or a close associate a PEP?

Yes No

*PEP -Politically Exposed Person -Is an individual who has been entrusted with a prominent public Function domestically or internationally or who is an immediate family member or close associate of the above.

If yes, relationship

Joint Applicant

Are you, any immediate family member or a close associate a PEP?

Yes No

If yes, relationship

Primary Applicant

If any of the (*) fields above have been updated, please upload relevant copies of the proof documents below:

A copy of NIC/Passport

Address verification – Please provide a utility bill issued within the last three months from the date of this form

Signature

Joint Applicant

A copy of NIC/Passport

Address verification – Please provide a utility bill issued within the last three months from the date of this form

Signature

Primary Applicant

Joint Applicant

Primary Applicant

Joint Applicant

Primary Applicant

Joint Applicant

Primary Applicant

Joint Applicant

Primary Applicant

Joint Applicant

Primary Applicant Signature

Joint Applicant Signature