Product Type / jahupg;G tif/ ksIamdok j¾.h Deposits /itg;G /;ekam;= Lease, Loan / Fj;jif flன்/ කල්බදු, ණය Savings / Nrkpg;G / b;sßlsÍï Other/NtW/ වෙනත්

01 Full Name of the Account Holder (Mr/Mrs/Ms/Rev) fzf;F cupikasupd; KOg; ngau; (jpU/jpUkjp/nry;tp) .sKqï ysñhdf.a iïmQ¾K ku (mQcH $uhd$ñh$fufkúh)

02 Permanent Address epue;ju Kftup iaÓr ,smskh Foreign Address (If applicable) ntspehl;L tpyhrk; (nghUe;jpdhy;) විවේශ ලිපිනය (අදාළ නම්)

03 Correspondence Address jw;fhypf Kftup ,sms túh hq;= ,smskh

04 Status of Residence/ trpg;gpl epiy / mදිxÑfhys ;;ajh Owner/cupikahsu;/ whs;slre On Rent / Lease thlif/Fj;jif

l=,shg / noaog Owned by Friend / Relative ez;gu;/cwtpdu; %yk; cupj;jhf;fg;gl;lJ ñ;=frl=g / {d;sfhl=g whs;s

Owned by Husband / Parents fztu;;/ngw;Nwhu; %yம் cupj;jhf;fg;gl;lJ; iajdñ mqreIhdg /foudmshkag whs;s

Official / mjpfhuG+u;t /ld¾hd,Sh Hotel / Lodge / Other ( P.I.) N`hl;ly; /yhl;[; / NtW (gp.I) fydagල් / kjd;eන් / fjk;a (i|yka lrkak)

Residential address to be verified and supported by one of the following documents / fPo;fhZk; VNjDk; Mtzq;fs; Fwpj;j egUila tjptplj;ij cWjp nra;jy; Ntz;Lk; / my; i|yka f,aLk w;=frka mÈxÑ ,smskh ;yjqre lr .ekSug Woõjk f,aLkh National Identity Card/ Nj.m.ml;il / cd;sl ye÷kqïm;

Passport/ flTr;rPl;L / úfoaY .uka n,m;%h

Driving License/ Xl;Ldu; cupkk; / ßhÿre n,m;%h

Confirmation of Tenancy Agreement/ epyf;Fj;jif xg;ge;jj;ij cWjpnra;jy; / l=,S .súiqïlr iy;slh

Income Tax Receipt/ tUkhd tup rPl;L / wdodhï nÿ ,ÿm;a

Utility Bill / gad;ghl;L gpy;/ පාරිවෙdගික ì,am;a

Statement of other Banks / Vida tq;fpfspd; $w;W / wfkl=;a nexl= .sKqï úia;r

A letter obtained by state Authority/ khepy mjpfhu rigaplkpUe;J ngw;Wf; nfhz;l fbjk; / rdcH අdයතනයකින් ලබාගත් ,smsh

Employment Contract / gzp xg;ge;jk; / /lshd fldka;%d;a;=j

Others (Specify) / Vida (tpNrl) / fjk;a (i|yka lrkak)

KNOW YOUR CUSTOMER (KYC) PROFILE– INDIVIDUAL cq;fs; thbf;ifahsupd; gpd;zdpia mwpe;Jf; nfhs;Sq;fs;; -jdpg;gl;lth;

Tnf.a mdßfNda.sl wdlD;sh - (KYC) – ;ks mqoa.,

(Requirement in terms of Financial Transaction Reporting Act No 6 of 2006) nfhLf;fy; thq;fy; mwpf;if rl;l ,y. 2006Mk; Mz;L ,y 06

(2006 wxl 06 orK uQ,H .Kqfokq jd¾;d lsÍfï mk;g wjYh jk fldkafoais)

05 Employment Information / Ntiytha;g;G jfty; //lshdව සම්බන්ධෙ වතොරතුරු Employment Status /பணி நிலை / රැකියා තත්ත්ෙය

Self-employed /

Rயத ொழில் /

ස්ෙයං රැකියාෙක නියුතු

Part-time employed /

பFதிநேரநேலை /

අර්ධ කාලීන රැකියාෙක නියුතු

Retired /ௐய்Tதபற்ற /

විශාමික

Full-time employed /

Kழ நேர பணி /

පූර්ණ කාලීන රැකියාෙක

නියුතු

Not currently employed /

ற்நபொJ நேலையில் இல்லை / දැනට රැකියාෙක

නියුතු නැති

Others (Specify) /

Vida (tpNrl) /

fjk;a (i|yka lrkak)

Occupation/ Position held /

நேலை/ேகித் ப வி /

රැකියාෙ / තනතුර

Name of the Employer /

நிறுேdத்தின் தபயர் /

වසේො වයෝජකයාවේ නම

Address of the Employer /

நிறுேdத்தின் விசொைம் /

වසේො වයෝජකයාවේ ලිපිනය

Nature of Business / ேணிகத்

ந்லை/ ෙයාපාරවේ ස්ෙොෙය

Manufacturing / உற்பத்தி / නිෂ්පාදන Import/ Export / ஏற்றுைதி /ආනයන / අපනයන

Finance/Insurance / நிதி/கொப்GUதி / මුලය/ රක්ෂණ

Wholesale / தைொத் விற்பலை / වතොග වෙළඳාම

Construction / கட்Uைொைம் /ඉදිකිරීම Communications /த எடஎபஎடல் / සන්නිවේදනය

Retail / சில்ைலர / සිල්ලර

Business Services /ேணிக நசலேகள்

/jHdmdr වසේො Transport /நபொக்Fேரத்J /m%ොහන Real Estate /ைலை /වේපළ වෙළදාම් Restaurants /உணேகம் /අෙන්හල් Public Services / தபொது நசலே /

වපොදු වසේො

Hotel /வி ;Lதி /වහෝටල් Gem and Jewelry /ைொமிக்கம் ைற்றும் ேலக/ මැණික් හා ස්ෙර්ණාෙරණ

Casino / Gambling house / Night Clubs சூ ொட்டம் / இரவு விLதிகள் / කැසිවනෝ / සූදු නිොස / රා;%S සමාජශාලා

Others (Specify) / Vida (tpNrl) / fjk;a (i|yka lrkak

……………………………………….

Personal & Household Services/

னிப்பட்ட ைற்றும் வீட்டு நசலேகள் / පුේගලික සහ ගෘහස්ථ වසේො

06 Contact Details njhlu;Gf;F ÿrl:k wxl

Home இFப்பிடk ksji

Mobile njஎைைநபசி cx.u

Office/ mYtyfk;/ld¾hdලිh

E Mail kpd;dQ;ry; úoHq;a ,smskh

07 Date of Birth / gpwe;j jpfjp / Wmka Èkh

Date jpfjp Èkh

Month khjk; udih

Year Mz;L wjqreoao

Citizenship / FbAupik/ mqrjeisNdjh Sri Lankan /,yq;ifau;/ Y%S ,dxlsl

Resident / FlpAhpik/වන්ොසික

Non Resident/ FlpAhpik my;yhj/

අවන්ොසික

Sri Lankan with Dual Citizenship / ,ul;il FbAupikAila ,yq;ifau; /Y%S ලාxlsl, oaú;aj mqrjeisNdjh ලද

Sri Lankan with Foreign Citizenship / ntspehl;L FbAupikAila ,yq;ifau;/ Y%S ,dxlsl, úfoaY mqrjeisNdjh ලද

Foreign National / ntspehl;L thrp / úfoaYsl Country/ ehL / රට ……………………. Visa Expiry Date / Tprh fhyhtjpahFk; jpfjp / වීසා කල් ඉකුත්ෙන දිනය …………………………………….

08 Place of Birth / gpwe;j ,lk; / Wmka ia:dkh

09 NIC / PP / DL / No Nj.m.m / frP/ Xc ,y (Please attach a copy) jaTnra;J gpujpfis ,izf;fTk;. cd;sl ye=÷kqïm;$ úfoaY ගමන් බලප;% / ßhÿre n,m;% / wxlh (lreKdlr msgm;la wuqKkak)

10 Purpose of the Account Opening / Usage fzf;F jpwg;gjw;fhd fhuzk; .sKqu විjD; lsÍfï wruqK / Ndú;h (Please Tick the relevant boxes) (rupahd $l;bDs; milaளkpLf)

(lreKdlr wod< fldgq ,l=Kq lrkak)

Utility Bill Payment /gad;ghLila gpy; nfhLg;gdT / පාරිවෙdගික ì,am;a f.ùï

Business Transaction/ tpahghu gரிkhw;wq;fs; jHdmdr .Kqfokqj

Savings / Nrkpg;G / b;sßlsÍï Investment Purposes/ KjyPl;L Nehf;fj;jpw;fhf wdfhdack wruqKq

Upkeep of Family / Personal expenses FLk;g ghJfhg;gpw;fhf mjq, kv;a;= lsÍu / mqoa.ලික වියදම්

Social and Charitable Purpose/ r%f kw;Wk; njhz;L Nehf;fj;jpw;fhf iudc iy mqKHdOdr wruqණු

Loan repayment fld; kW nfhLg;gdT Kh wdmiq f.ùu

Security for Loan / Employment fld; ghJfhg;gpw;fhf / Ntiy tha;g;G Kh uqo, i|yd wdrlaIdj / rlaIdj

Family Inward remittances FLk;g gz mYty;fs; mjq,ට uqo,a tùu

Others Vida fjk;a

Foreign Passport holders (Dual Citizens / Resident in or Employed in Sri Lanka) (Please give the reason for opening the account in Sri Lanka)

ntspehl;L flTr;rPl;L itj;jpUg;gth; (,ul;il FlpAhpik ,yq;ifapy; FlpapUg;G my;yJ gzpahw;Wgth;) (,yq;ifapy; fzf;F

jpwg;gjw;fhd fhuzk; nfhLf;fTk;) විවේශ ගමන් බලප;% හිමි (ේවිත්ෙ පුරෙැසියන් / Y%S ලංකාවේ පදිංචි වහෝ රැකියාෙක් කිරීම (කරුණාකර Y%S ලංකාවේ

ගිණුම විෙෘත කිරීමට වහේතුෙ i|yka lrkak))

11 Source of funds - Expected source and nature of credit in to the account epjp Mjhuk; - fzf;fpYs;s epjpapd; Njhuk; kw;Wk; jd;ik wruqo,a m%Njh - wfmalaIs; මුදල් m%Njh iy බැර කිරිමි ෙල iajNdjh (Please Tick the relevant boxes) rupahd $l;bDs; milaskpLf (lreKdlr wod< fldgq ,l=Kq lrkak)

Sales and Business Turn Over tpw;gid kw;Wk; ேணிக ேFேய் úl=Kqï iy jHdmdr wdodhï

Donations Charities (Local / Foreign) ed;nfhil njhz;L (cs;ehl;L / ntspehl;L) mqKH lghq;= i|yd mß;Hd. (foaYSh / úfoaYSh)

Family Remittances FLk;gj;jpd; %yk; mjq,g uqo,a tùu

Sale of Property / Assets nrhj;J / Mjdk; tpw;gidapd; %yk; foam, හා ෙත්කමි úl=Kqï

Commission Income tUkhdj;jpd; xU gFjp fldñia wdodhï

Gift / Inheritance gupR / guk;giu Mjdk; ;Hd./odhdo හා Wreමකමි

Export Proceeds Vw;Wkjp %yk; wmkhk wdodhï

Investment Proceeds KjyPL %yk; wdfhdack wdodhï

Contract Proceeds xg;ge;jj;jpd; %yk; fldka;%d;a wdodhï

Membership Contribution cWg;gpdu; iudðl uqo,

Salary / Professional Income rk;gsk;/ njhopy; tUkhdk; jegqma / jD;a;Sh wdodhï

Others (Please specify) Vida (Fwpg;gplTk;) fjk;a (lreKdlr i|yka lrkak)

Other connected Business/ Professional activities NtW ,izf;fg;gl;l tzpf / njhopy;Kiw eltf;iffs; kw;Wk; tlK වෙනත් jHdmdr / jD;a;Sh ක්රියාකාරකමි

12 Expected mode of Transaction Cash Cheque Fund Transfer Other (Specify) vjpu;ghu;f;Fk; gupkhw;wy; Kiw பணம் fhNrhiy epjp gupkhw;wk; Vida (Fwpg;gplTk;) wfmalaIs; .Kqfokq කරන මාධය uqo,a fplam;a uqo,a yqjudrej fjk;a (i|yka lrkak)

13 Average Monthly Income - ruhrhp khjhe;j tUkhdk; / සාමානය මාසික ආදායම

Less than Rs. 50,000 / w;Fk; Fiwa & 50,000 / jvd wvq re. 50,000

Rs. / &./ re. 50,001 -100,000

Rs. / &./ re. 100,001- 250,000

Rs. / &./ re. 250,001 - 500,000

Rs. / &./ re. 500,001 – 1,000,000

More than Rs. 1,000,000 / w;Fk; mjpfkhf &. 1,000,000 / jvd jeä re. 1,000,000 ට

14 Anticipated Volumes per month / vjpu;ghu;f;fg;gl;l msT / udisl wfmalaIs; fma%ෂණ

Less than Rs. 100,000/- / w;Fk; Fiwa &. 100,000/- / ෙvd wvq re. 100,000/-

Rs. / &./ re. 100,001 -500,000

Rs. / &./ re. 500,001 -1000,000

More than Rs. 1,000,000 / w;Fk; mjpfkhf &. 1,000,000 / ෙvd jeä re. 1,000,000 15 Are you Owner/s, Partner/s, Director/s, Official/s, or any family member or close associate of a politically exposed person?

cq;fSila> cupikahsUila / gq;FjhuUila/ gzpg;ghsUila/ epWtd uPjpahf my;yJ VNjDk; FLk;g mq;fj;jtu;fs; murpaypy; gpd;tUk; jfty;fis epug;Gf / Tõ kï" lreKdlr my; f;dr;=re imhkak' Name of the person that you have a relationship / ePq;fs; cwT nfhz;Ls;s egupd; ngau; / Tn iu`. iïnkaO;djh we;s mqoa.,hdf.a ku : ………………………………………………………………………………………….. Relationship between you and above person / Nkw;Fwpg;gpl;l egUf;Fk; cq;fSf;Fk; ,ilapyhd cwT / Tn iy by; i|yka mqoa.,hd w;r iïnkaOh: ………………………………………………………………………………………….. Are there any ownership / connection of the funds that you deposit to the above person? ePq;fs; itg;Gr; nra;j epjpf;Fk;/ cupj;Jf;Fk; Nkw;Fwpg;gpl;l egUf;Fk; VNjDk; njhlu;Gs;sjh? by; mqoa.,hdg Tn wdfhdackh l< uqo,a w;r iïnkaOhක් / lsසිhï ysñldÍ;ajhla ;sfío? ………………………………………………………………………………………………………………………………………………

16 I do hereby confirm that the monies I have deposited have been obtained purely from legal sources. ehd; itg;G nra;Js;s gzkhdJ cz;ikapy; rl;luPjpahd Kiwapy; ngw;Wf; nfhs;sg;gl;lit vd cWjpaspf;fpd;Nwd;. ud úiska wdfhdackh l< uqo,a kS;suh uQ,dY% hgf;a පමණක් ලබාගත් nj ud iy;sl lrñ' ………………………………………………………………… ……………………………………… Signature of the customer /thbf;ifahsupd; ifnahg;gk; ගණුවදණුකreොf.a w;aik Date/ jpfjp / Èkh

COMPANY USE ONLY / mYtyf cgNahfj;jpw;F khj;jpuk; / iud.fï m%fhdackh i|yd muKs'

1 Verification of Name / Gender / Nationality - ngau;/ ghy;/ gpu[hTupik rupghu;j;jy; - ku$ia;%S mqreINdjh$cd;sය ksrjoH;djh Supported documents accepted Jiz Mtzq;fs; Vw;Wf;nfhs;sg;gl;lJ. අමතර ,shlshú,s wkqu; lsÍu

2 Verification of Residential / Permanent Address - jw;fhypf/ epue;ju tjptplj;ij rupghu;j;jy;- mÈxÑh$iaÓr mÈxÑය ksrjoH;djh Supported documents accepted Jiz Mtzq;fs; Vw;Wf;nfhs;sg;gl;lJ. අමතර ,shlshú,s wkqu; lsÍu

3 Source of Fund identified epjp Mjhuk; ,zq;fhzg;gl;lJ. uqo,a uQ,dY% y÷kd.ekSu

4 Does the customer appear in a Suspected Terrorist List (Sanction List – UNSCR 1373 / 1267/1988) or any other Alert List: Thbf;ifahsh; xU re;Njfj;jpw;Fhpa gaq;futhj gl;baypy; cs;slf;fgLgtuh? අදාල පාරිභ ෝගිකයා එක්සත් ජාතින්භේ සම්බාධක තන්;%යට අනුෙ සැකභකභෙන ;%ස්තවාදින්භේ ලැයිස්තුෙට (සම්බාධක තන්;%- UNSCR 1373/1267/1988) අeතුලත්ද?

Yes /Mk /; ඔේ No / இல்லை /නැත If yes (Specify): Mk; vd;why; (Kd;itf;fTk;) / ඔේ නම්(i|yka lrkak) ……………………………………………………………………………………………………………………………………………………………………………………………………

5 Risk Assessment இடர் mstply; wjodkï ;lafiarej

Low / Fiwa/ wju Medium /rkepiyahf/ uOHu High /mjpfkhf/ Wmßu

6 Name & Designation of the Officer / cj;jpNahfj;jupd; ngau; & gjtp ks,Odßhdf.a ku iy ;k;=r

7

…………………………………… ………………………………………… Signature of the Officer / cj;jpNahfj;jupd; ifnahg;gk; /ks,Odßhdf.a w;aik Date / jpfjp / Èkh