Know Your Customer (Kyc) Profile Form Individual/company Form

No. 2, Deal Place, Colombo 03, Sri Lanka.

Telephone: + 94 11 2639 898/ + 94 11 2576 878

Fax: +94 11 2 639 899/+94 11 2 576 866 Email: info@firstcapital.lk

KNOW YOUR CUSTOMER (KYC) PROFILE FORM INDIVIDUAL/COMPANY

INFORMATION

1. Account Name

2. Occupation & Name of

Employer / Nature of

Business

3. Citizenship

Nationality

Sri Lankan

Sri Lankan with dual citizenship

Type of Visa

Foreign national

Expiry date

4. Client type

Individual/Joint

Private Limited Company

Club/ Societies/Charities/Associations

Proprietor / Partnership

Public Limited Company

Trust /NGOs

5. Name, Date of birth and Nationality /Company registration verification

National Identity Card

Passport

Certificate of Incorporation

Other (Specify)

6. Address verification

National Identity Card

Bank statement

Letter from a public Authority

Tenancy Agreement

Utility bill

Income Tax Receipt / Assessment Notice

Driving License

Employment contract

Other (Specify)

7. Status of the Residential/Registered Address

Owner

Lease/Rent

Friends / Relatives

Parents

Official

Board/ Lodging

8. Permanent/Registered

Address

9. Source of funds (Tick as applicable)

Sales and business turnover

Contract proceeds

Investment income

Family Remittances

Donations / Charities (Local/ Foreign)

Gifts

Commission income

Salary / Profit / Professional Income

Membership contributions

Export Proceeds

Sale of property and assets

Other (Specify)

10. Anticipated volumes

Less than 100,000

1,000,000 to 2,000,000

5,000,000 to 7,000,000

100,000 to 500,000

2,000,000 to 3,000,000

7,000,000 to 10,000,000

500,000 to 1,000,000

3,000,000 to 5,000,000

Above 10,000,000

BUSINESS INFORMATION (only in the case of Business & Non Personal Accounts)

11. Assets owned by the business and their values

Property/ Premises

LKR

Motor vehicle

LKR

Financial Assets

LKR

Investments

LKR

Other (Specify)

LKR

12. Major Customers/ Suppliers

& Other Connected Parties

Note: In the event of any changes to the above stated information must be duly notified to First Capital.

Date

Customer Signature

Know Your Customer (Kyc) Profile Form Individual/company Form - First Capital

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