Individual Application Form
Personal Details
Full name (With initials)
Date of Birth
Postal Address
NIC/Passport
Citizenship
Nationality
District
Postal Code
Country
Client Type
Contact Information
Telephone Number
Contact Number
Email
Fax Number
Bank Details
Bank
Branch
Type of Account
Account Number
Address Verification
Permanent Address
Address Verification
Address Verification
Employment Contract
Tenancy Agreement
Statement of Other Banks
Letter of Public Authority
Income Tax Receipt
Utility Bill (Specify)
Ownership of Residence
Owner
Official
Parents
Friend/Relatives
Lease/Rent
Upload Documents
Attach NIC/DL or Passport
Attach Proof of Address
Download application
Fund Type
Investment Amount
Source of Funds (Tick all Applicable)
Business Income
Family Remittances
Commission Income
Salary / Profit Income
Investment Proceeds
Export Proceeds
Contract Proceeds
Gift
Membership Contribution
Others
Applicant's/ Business' Ownership of Wealth and Estimated Value (Only the Corporates)
Residential Property (Rs.)
Financial Assets (Rs.)
Business Premises (Rs.)
Motor Vehicles (Rs.)
Investments (Rs.)
Others – Specify (Rs.)
Ancipated Volumes of Deposits from above source (in Rupees)
Less than 100,000/-
100,000/- to 500,000/-
500,000/- to 1,000,000/-
1,000,000/- to 5,000,000/-
Above 5,000,000/
Occupation
Company Name
Postal Address
Tel
Fax
Email
Nominee's Name
Status
Nominee's Address
Relationship to Nominee
Title
Name of Applicant
Postal Address
NIC
Passport
Date of Birth
Nationality
District
Country
Contact Information
Telephone Number
Contact Number
Email
Declaration
I/We hereby confirm that the above information provided to you is true and correct to the best of our knowledge. I/We acknowledge that if the information provided is found to be false or misleading then the business relationship may be annulled anytime at your discretion. I/We hereby agree to provide any additional information/documentation that may be required.
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Attach Signature
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