Know Your Customer (KYC) Prole Form
(Requirement in terms of the Financial Transaction Reporting Act No 6 of 2006)
SECTION (A) – CLIENT INFORMATION
Please (P) the boxes as appropriate.
Customer Code:
(for Office Use)
1. Client Type:
5 Individual/Joint
5 Clubs/Societies/Charities/Associations
5 Proprietorship/Partnership
5 Corporate (Ltd Liability)
5 Others (Specify)…………………………..
2. Name of Client:
3. Name/s with initials: (Owner/s, Partner/s, Director/s, Official/s)
i. ……………………………………………………………………………………………………………………………………..
ii. ……………………………………………………………………………………………………………………………………..
iii. ……………………………………………………………………………………………………………………………………..
iv. ……………………………………………………………………………………………………………………………………..
v. ……………………………………………………………………………………………………………………………………..
4. (a) Occupation / Public Position:
5. Name & Address of the Employer:
(b) Nature of Business:
6. Nationality & Citizenship:
7. Are You, Owner/s, Partner/s, Director/s, Official/s a Tax payer/ Residents of the United States?
NB: if ‘Yes’, please complete the attached form with relevant details.
5 Yes
5 No
SECTION (B) – ACCOUNT INFORMATION
1. Account Type:
5 LKR Savings Account (specify category)…………………………
5 FCY Savings Account (specify category)………………………
5 LKR Fixed Deposit (specify category) ……………………………
5 FCY Fixed Deposit (specify category) …………………………
2. Purpose for opening an account:
5 Business Income
5 Family Inward Remittance
Item 3870
5 Employment / Professional Income
5 Loan Payment
5 Savings / Investments
3. Source of funds and/or nature of credits into the account:
5 Business Income
5 Salary / Profit Income
5 Others (Specify)
5 Family Inward Remittance
5 Others (Specify)
5 Donations Charities (Local / Foreign)
5 Sale of Property / Assets
4. Deposit value /expected value of credits to Savings Account: (Equivalent Rupee value)
(a) Individuals:
5 Less than 100,000/5 100,000/- to 1,000,000/5 Above 1,000,000/(b) Others:
5 Less than 1,000,000/5 1,000,000/- to 3,000,000/5 Above 3,000,000/-
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