KYC coral - 08 11

Know your Customer - KYC Form 1 ^.Kqfokqlre yªkd.ekSu&
Requirement in terms of Financial Transaction Reporting Act No. 06 of 2006 - fuu f;dr;=re 2006 wxl 06 orK uq,H .KqfoKq jd¾;d lsÍfï mkf;a wjYH;djhks
FOR OFFICE USE ONLY - ld¾hd,Sh m%fhdackh i|yd muKhs
ETI FINANCE LIMITED.
DATE
No. 114, Ward Place Colombo - 07
A/C NO
:..............................................
CIF NO
:..............................................
:..............................................
Customer Information - (Individual / Joint) / .Kqfokqlre ms<sn| f;dr;=re - ^;ks mqoa., $ noaO&
1. Full Name of the Customer/.Kqfokqlref.a iïmQ¾k ku(
2. Occupation/Employment/Self Employment & Position:
jD;a;Sh$ /lshdj, iajhx /lshdj iy ;k;=r(
3. Name & Address of Employer/ fiajd fhdaclhdf.a ku iy ,smskh(
4. Contact Details / iïnkaO;d f;dr;=re
4. 1 Contact Numbers/ÿrl:k wxl ( Residnce/ksji(..................................Mobile/cx.u(................................Office//lshd ia:dkh(.............................
4.3 E-mail/úoaHq;a ,smskh(. ................................................................................................
4. 2 Fax/*elaia wxlh(.....................................
4. 3 Permanent Address / iaÒr ,smskh (............................................................................................................................................................................
5. Name, Date of birth and Nationality verification/ ku Wmka oskh iy cd;sh ikd: lsÍu(
To be supported by one of the following accepted documents/ fuh my; i|yka ms,s.; yels ,shlshú,s
Drivng License No:
National Identity Card No:
ßhÿre n,m;% wxlh(.................................
cdlsl ye÷kqïm;a wxlh(....................................
Armed Forces Service Card
Birth Certificate (minor)
yuqod ye÷kqïm;
Wmamekak iy;slh ^nd,jhialrejka&
w;=ßka tlla u.ska ;yjqre l< hq;=h
Passport No:
úfoaY .uka n,m;% wxlh(.......................................
Other (Specify)
fjk;a ^úia;r lrkak&
...............................................................................
6. Address verification/ mosÑh ikd: lsÍu (Residential address verified and supported by one of the following acceptted documents/mosxÑ ia:dkh my;
i|yka ms,s.; yels ,shlshú,s w;=ßka tlla u.ska ;yjqre l< hq;=h
National identity Card
Bank/Credit card Statements
Income Tax Receipt
nexl= .sKqï$ Khm;a m%ldYk
cd;sl ye÷kqïm;
wdodhï nÿ ,ÿm;a
Utility Bill (Specify)
Tenancy Agreement
Assessment Notice
Wmfhda.s ì,am;a ^úia;r lrkak&
l=,S ksjeis .súiqu
;lafiare oekaùu
Employment Contact
Driving License
Other (specify)
/lshd .súiqu
ßhÿre n,m;%h
fjk;a ^úia;r lrkaak&
For Office Use Only
N. B. For items 5&6, a copy should be retained & stamped Original Seen / ie,lsh hq;=hs( whs;u wxl 5 iy 6 i|yd uq,a msgm;a mÍlaId l< njg uqødj
fhdod msgm;la r|jd .; hq;=h
Put a (x) on the relevant cage.
7.Source of Funds to the Account/uqo,a W;amdokh jQ uQ,dY%h(
Business Income
jHdmdr wdodhï
Investments
wdfhdack wdodhï
Employment/Professional Income
/lshdfjka $ jD;a;sfhka ,o wdodhï
Donations (local/Foreign)
wdOdr ^foaYSh$úfoaYSh&
8. Purpose of opening the Account/.sKqï wdrïN lsÍfï mrud¾:h
Family inward remittances
Saving/Investment
b;=reï$wdfhdack
mjq,g ,efnkakjQ fma%IK
Business Transaction
Utility bill Payment
jHdmdr .Kqfokq
Wmfhda.s ì,am;a f.ùï
Employment/Professional Income
Upkeep of family/person
/lshdfjka$jD;a;sfhka wdodhï
mßfNdack úhoï
Bank facilities
nexl= Kh myiqlï
Other (Specify)
fjk;a ^úia;r lrkak&.................................
Loan repayment
Kh f.ùï
Share trading
fldgia .Kqfokq
Social & Charity work
iudc yd mqKH lghq;=
Other (Specify)/ fjk;a ^úia;r lrkak&
:........................................................................................................................................................................................................................................
9. Monthly Income (Rs.)/ udisl wdodhu ^remsh,a&
0 to 50,000/=
50,000/= to 100,000/=
10. Tax Liability/nÿ j.lsu(
100,000/= to 200,000/=
200,000/= to 500,000/=
No/ke;
yes/we;
Percentage/m%;sY;h................%
500,000/= to 1,000,000/=
1,000,000/= above/by<
File No/,sms f.dkq wxlh(......................................