Type of Account IndividualJoint

Customer NewExisting

For Office Use Only

Date

1.0 Main Applicant

Title MrMrsMissDrRev 1.1 Last Name with Initial 1.2 Name in Full 1.3 NIC 1.4 Date of Birth 1.5 Gender MaleFemale 1.6 Nationality Sri LankanForeign National 1.7 Permanent Address 1.8 Mailing Address 1.9 Mobile No 1.9.1 Residence & Office Tp 1.10 email 1.11 Fax 1.12 Occupation / Position Held 1.13 Name and Address of the Employer 1.14 Marital Status MarriedSingleOther 1.15 Name of Spouse 1.16 Tax File No 1.17 Automated Services SMS Services (Interested)

1.18 Joint account will be operated by Anyone of usAll of usOther

02. Investment Particulars

2.1 Mode of Payment Full PaymentMonthly Payment 2.2 No of Vanilla pods Agreed to purchase 2.3 Land Extent 2.4 Amount (in figures) LKR (in words) LKR 2.5 Harvest return rate 2.6 Period - Months 2.7 Please Credit/ Returns at MonthlyAnnuallyOther 2.8 Renewal Instruction Capital & ReturnsCapital Only 2.9 Beneficiary Name 3.0 Beneficiary Account No 3.1 Beneficiary Bank 3.2 Beneficiary Branch Attach Passbook Copy