E-mail: pensions0)sltnet.lk

Web site: www.pensions.gov.lk

Telephone2329580232043924344142431612

Amendment to the Circular dated25.09.2,009

PolicyForcesComputationPayments

Fax243221423323472342525

Telephone2332346232437523425252329178

W&OPP5PFL.G.U.Registration

~~)@ aogd G~a)t5e5)(~@e55~a~ tiJ61!,~tiJt6;;"~ 6lD6OOT8id>6TTLDDEPARTMENT OF PENSIONS

UlIr61~ffirr6lJIii6<ll1bGIfW6\Ja;W, UlIT~a;rT6lJIii6<llIb,Ga;rr@wl.l 10. Maligawatte Secretariat, Maligawatte, Colombo 10.

Fax2342078234207823914032329634

Telephone2431647243200824349742329634

Pension Circular 16/2009 (Amendment)

Heads of Overseas Missions,

District Secretaries,

Divisional Secretaries,

Bank Managers,

Pension Circular 16/ 2009 dated 25.09.2009 issued under above heading is repealed and this

circular is substituted.

(a) Background to the payment of overseas pension

PAYMENT OF PENSION TO SRI LANKAN PENSIONERS RESIDENT ABROAD

Nearly 25,000 Sri Lankan pensioners are living in foreign countries and most of them are in

Australia (including New Zealand) India, Canada, United Kingdom and United States of

America. Also a considerable number of pensioners are living in Middle East Countries and

Western Countries.

Several reasons have been caused for Sri Lankan pensioners to reside in foreign countries, such as

return of English officers to their homeland after serving in Sri Lanka, migration of Sri Lankan

officers to foreign countries after retirement on official language policy, ethnic crisis and

migration of pensioners to foreign countries to live with their children.

Various methods during recent past were followed by the Department of Pensions in order to pay

pension to Sri Lankan pensioners resident abroad. Payment methods such as through Crown

Agent Pension Units in United Kingdom, Pay & Accounts Office in India and Sri Lanka overseas

Missions were adhered while considerable number of pensioners reside abroad were used to draw

pension through bank accounts maintain in Sri Lanka.

Director GeneralDirectorDirector (F)

Internal Auditor

- ....

-........•

Nevertheless the fact that many pensioners live abroad the Department of Pensions had

no details of most of them. Furthermore the payments have been made during past

without any due method or management. Number of cases such a.s pensions of overseas

pensioners had been drawn by other persons through joint accounts was revealed. Having

considered these matters the Department of Pensions has decided to reorganize pension

payment methods of Sri Lankan pensioners resident abroad.

(b) New method of payment of pension to Sri Lankan pensioners resident

abroad

Decision was taken to cancel payment of pension through Crown Agent Pension Unit in

United Kingdom and Pay & Accounts Office in India. The method of crediting pension to

a local bank account in respect of pensioners living abroad will be further formalized.

Decision has been taken to pay Civil Pension or Widows' & Orphans' Pension to

pensioners resident abroad in accordance with following procedures under new method;

viz. through Sri Lanka overseas Missions or through a special bank account in a local

bank. Further, facility will be available to draw pension via Divisional Secretariats

subject to certain conditions.

01. Payment of pension through Embassies/ High Commissions of Sri Lanka

This payment method will be restricted for 5 countries such as Untied States of America,

United Kingdom, Canada, India and Australia. Pension will be made only through a

selected Sri Lanka Mission in those countries. Accordingly, these payments will proceed

through Embassy of Sri Lanka in Washington DC, High Commission of Sri Lanka in

London - United Kingdom, High Commission of Sri Lanka in Ottawa and Deputy High

Commission in Toronto - Canada, High Commission of Sri Lanka in Canberra -

Australia and Deputy High Commission of Sri Lanka in Chennai - India. Payment of

pension through Consulate General Offices in those countries will be cancelled.

Pensioners in New Zealand will be paid through High Commission of Sri Lanka in

Canberra - Australia. Pension will be paid in compliance to the following instructions.

2

1. Pension file for each country will be created and maintained by this department.

Said payment files will be dispatched to above paying Missions monthly. Embassy/

High Commission should pay pension refer to the file.

11. Pension will be paid by the Mission subject to the verification of pensioner's

survival and receipt of life certificate. These payments can credit to the bank

account of respective pensioner. Payments through cheques will be further

permitted only if there any issues of crediting pension to bank accounts.

111. Instead of providing allocations to each Mission the whole amount required for

pension payments will be released to the Ministry of Foreign Affairs monthly. The

ministry will take action to send the required money to the relevant Embassy/ High

Commission monthly. Accordingly it is possible to pay pension to overseas

pensioners at the same date when the pension paid to pensioners in Sri Lanka.

IV. Each Mission should send respective monthly payment details to the Department of

Pensions.

v. Pension payments maintained by Embassies/ High Commissions/ Deputy High

Commissions are cancelled and payments should be done only in compliance to the

monthly payment file created by this department.

VI. It is compulsory to send duly completed Data Entry Forms (through the Mission) by

all pensioners and entering Sort-code of the bank account would be more helpful for

prompt payment.

3

F---General instructions to Missions to making payments

1. Monthly pension file will create by the Department of Pensions and will dispatch to

Missions from January 2010. Said data will be available on official website

www.pensions.gov.lk.

11. Pension should be paid in compliance to the monthly pension file created monthly

by the Department of Pensions.

lll. Information provided by pensioners via Data Entry Forms will be used to create

monthly pension file. Pension of the pensioners who had not submitted information

will be temporarily nullified. Those pensions will be paid together with arrears from

the immediate month after receipt of information. Action will be taken to inform

relevant changes to the Mission. Therefore, all pensioners resident abroad should

compulsorily submit their information to this department via Data Entry Forms.

IV. Pension should be paid subject to the satisfactory of pensioner's survival. Life

certificate should be collected at least quarterly to get verification of pensioner's

survival. If there is any obstacle to collect life certificates quarterly should be

collected at least once in year.

v. Payment of penSIOn shall nullify in terms of Minutes on Pensions due to

imprisonment of a pensioner. This condition is applicable even to overseas

pensioners and pension of such pensioners should be nullified accordingly.

VI. Heads of Missions are free to create Life Certificate in compliance to Annexure 2 or

as they preferred. However the Life Certificate should be certified by a suitable

officer. Accordingly an officer in Mission, Chief Incumbent or a Priest of a religion,

officer in Army, Navy and Air Forces migrated from Sri Lanka or any other

government officer, Doctor, Engineer, Accountant or Notary Publici Justice of

Peace or a person accepts by the Mission are eligible to certify the life certificate.

Ratification by a pensioner himself is adequate, if the pensioner personally call over

the Mission to submit the life certificate.

4

vii. Verification such as the pensioner has not remarried is required to the payment of

widows' pension. An affidavit should be collected from the widow/ widower once

in each year together with life certificate to verify whether not remarried.

(02) Payment of pension through approved special bank account

All pensioners resident abroad are given opportunity under this method to open a special

bank account at a bank in Sri Lanka and to get credited monthly pension to the account.

i. This special account can open at People's Bank - Queen's Branch where the

Department of Pensions maintained its main account. Facilities are available for

pensioner to open this bank account having arrived in Sri Lanka or while in

overseas. This facility will be available at the BOC - Metropolitan Branch from

March 2010.

ii. Pensioners are required to submit duly filled Mandate form, Affidavit, Letter of

Consent in order to open this account. Documents submitted by pensioners while in

overseas countries should be ratified by Ambassador/ High commissioner or an

assigned officer at the Mission. The application will be certified by the Department

of Pensions, if the pensioner arrived in Sri Lanka. (application forms to open bank

accounts can download from the websites of the People's Bank and Bank of

Ceylon)

iii. Conditions are applicable to these overseas accounts.

Maintaining joint accounts or ATM cards are not allowed. Money of those accounts

can withdraw by pensioners themselves after arrived in Sri Lanka.

iv. Money in these accounts can transfer to other accounts. Accordingly the relevant

request should be forwarded to People's Bank (Manager, Quean's Branch) / Bank

of Ceylon (Manager - Metropolitan Branch) as per the specimen.

5

- .. ,,-

IV. Pension will be directly credited to pensioner's bank account and pensioners are

required to submit life certificates to this department once in each quarter. Life

certificate in each month should be submitted to the bank branch if the money

transferred to other accounts.

v. This department will take action to instruct bank officials regarding payment of

arrears to heirs after the death of pensioner.

(03) Payments through Divisional Secretariats

Pensioners visiting foreign countries for a short period should inform the Divisional

Secretariats. Those pensioners will be given opportunity to temporary nullifying their

pension until they are arrived in Sri Lanka or to draw pension through Divisional

Secretariat. When the pension paid through Divisional Secretariats for pensioners

resident abroad it is required to identify whether pension is paid to correct pensioner. All

pensioners are required to submit life certificates to the bank where they draw pension

and the Divisional Secretariat. Payment of pension shall nullify if the life certificate has

not submitted. All pensioners resident abroad are compulsorily required to submit duly

filled Data Entry Forms. Persons visited abroad for employment and attached to overseas

armed forces, pensioners hold dual citizenship and pensioners with Sri Lanka citizenship

are further paid pension through Divisional Secretariats. Approval from this department

should be availed for such payments.

In terms of the Minutes on Pensions and Widows' and Orphans' Pensions Act, the

pension cannot entrust to any other person. Therefore pensioners cannot open accounts to

credit pension to the names of persons hold their power of attorney or any other.

6

Fore:gn pension branch of this department can contact through following m~ans.

l

Address : Assistant Director, Foreign Pension Division,Department of Per ISions, Colombo 10, Sri Lanka.

Tel. ~:-.Jo. :+94 11 3 0305111 3 030512Fax No. :+94 11 2 342078e-mail address:pensions@sltnet.lk

foreignpensions@gmai!.comSkype addresS: fpensions .

04 Payment of pension to IOi:algovernment pensioners resident abroad!

(Thi~;is an substitute to the Pensicn Circular 16/2009 (3)- Local Government)

Payment of local government peLsion and widows' & orphans' p(msion is centralized tothe Department of Pensions. Thc:efon~ local government pensioners resident abroad arenot paid pension through Divisiolal Secretariats in future. Accordingly th,~pension willbe paid through,

4-1 Embassies / High Commissions of Sri Lanka

4-11 Crediting pension to specill bank account.Previously mentioned instructions should be followed for the paym ent of pensionunder these methods. Accordingly the data entry forms should be fo::warded to thefollowing address.

Chief AccountantLocal Government Pension Division.Department of PensionsColombo 10Sri Lanka.

Tel: +94 11 2 342525/ +94 1I:2 342526Fax': +94 11 2 342078 i

K A ThilakaratneDirectclr General of Pensions

Copies to

1. Secretary to the President

~:. Secretary to the Prime Minister

.3. Secretary to the Cabinet o::Ministers

4. Secretary - Ministry ofPuJlic Administration and Home AlTairs

5. Secretary - Ministry of Fillance

6. Secretary- Ministry of Fcreign Affairs

7. Auditor General

7

2 CertifiedPassport sizePhotograph

Data Entry Form of Pensioners Resident Abroad(FiH this Form using with only Block Capitals)

I Resident Country:

Fill in where Applicable

01. Personal Details of the Pensioner

i) Pension Type

ii) Pension Number:

CivilW&OP

ForcesLocal Government

iii) W&OP Registration Number

iv) Widows'IOrphans Pension Number: crrrTTTI(Only if drawing W&OP at present)

v) Last Name with initials:

vi) Name using for pension purposes

vi) Names denoted by Initials

Country

I

viii) Details of Permanent Resident:

a) Permanent Resident Card No :

b) Foreign Passport No :c) The Date received of Permanent Resident: D DIM M I Y Y Y Y

d) Whether have dual Citizenship: DYes 1__ INod) If so Address in Sri Lanka:

1own! Llty

Post Code I Telephone:

ix) Sex: Male: Female:

x) Date of Birth: D D 1M M I Y Y Y Y

xi) National 10 No (Sri Lanka):

xii) Civil Status: MarriedBachelor

WidowDivorced

xiii) The Period Resident abroad: Years Months Days

xiv) E-mail:

xv) Web Address:

xvi) Telephone No :

xvii) Fax No:

II

I) Is Spouse Living Yes No

II) Full Name of the Spouse:

III) NIC Number of Spouse :

IV)

V)

Permanent Resident Card No :

Date of Birth of Spouse: DD/MM/YYYY

VI) If Spouse is living in another place or in another country ( Give Details)

03. Details of Dependents.

Name Date of Birth Sex Civil EUDDDIMMIYYYY (M/F) Status (MIS)

Last Name First NameI2345

Sex:Civil Status:

M -MaleM - MarriedE - Employed

F- FemaleS - SingleU - Unemployed D-Disable

04. Pension Payment Details - Procedure of drawing pension at present

I. Present method of drawing pension

High Commissioner

Embassy

Consulate General

Sri Lanka

DDDD Bank & Account No. If a joint account, name &

address of the account partner I~ _

III

F:------

.. II. The address of High Commission or Sri Lanka Embassy which preferred to draw pension.

•

05. Particulars of Banks which pension is to be paid abroad.(for pensioners draw pension throughforeign missions)

CountryBankBank BranchAddress

Account No.(overseas)E-mail Address of Bank BranchWeb AddressFaxNoTele hone No.

06. If a special account at People's Bank - Queen's Branch or Bank of Ceylon - Metropolitan Branch was

opened,Account No .(Facility to open an account is available for pensioners who have not opened above account)

07. Month and Year of which the pension drew for last .

N.B. Please read updated Pension Circular 16/2009 (Amendment)

09. Data Entry Form should be supported with following attachments1. 02 photographs in passport size2. Photocopies of passport (photograph affixed page and visa approved page)3. Certified copy of citizenship or permanent resident card4. If prefer to draw pension by bank account at People's Bank - Queen's Branch or Bank of

Ceylon - Metropolitan BranchAccount Opening Information FormKYC (Know Your Customer) Profile FormLetter of Consent

5. Ifa widows'/ widowers' & orphans' pension, Widows'/ Widowers' Declaration Form

Signature of the Pensioner.

(Pensioners resident abroad should furnish this form through Sri Lanka Mission abroad)

IV

I declare that Mr/Mrs ................................................................ placed his/her signature before me this. . . . . . . . . . . .. . .. . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . day 0f at

Name

Signature of Attester(Authorized officer of the Mission)

Designation

Address

Please send above details to reach below address.

Assistant DirectorDepm1ment of pensions,Foreign pension Branch,Colombo 10,Sri Lanka

TelEmailFaxWebSkype Address

: :+94 11 3 030511/ 3 030512: pensions@sltnet.lk; foreignpensions@gmail.com: +94 11 2 342078: www.pensions.gov.lk: fpensions

•Duly filled forms of Local Government pensions should forward to reach at:

Chief AccountantLocal Government Pension DivisionDepm1ment of PensionsColombo 10.Sri Lanka

•

TelFax

: +94 11 2 320439: +94 11 2 342078

K A ThilakaratneDirector General of pensi ons

1) Please logon to www.pensions.gov.lk for downloading this form.

2) If both widow and widower are pensioner should fill two copies of this

form.

3) Not sending of this form shall liable temporary discontinuation of

payment of pension .

v

•

•

•

IN CASE OF WIDOW/ WIDOWERS PENSIONPART 1

AFFIDAVIT

Mrs/Mr. .

HEREBY SOLOMNLY, SINCERELY AND TRULY MAKE OATH and state as follows:

1. My maiden name as per my birth certificate.

2. After my marriage I use my name as.

3. My other names.

I confirm and declare that the statement contained in this affidavit is true to the bestof my knowledge and belief.

Signature.

Sworn at '" .On this .

Before me,

VI

."

., PART IIWIDOWS / WIDOWERS DECLARAION

I, .(Full name)

of .(Address)

do solemnly and sincerely declare that I was born on .(Date of Birth)

that I married the late ,(Full name &designation of husband/wife)

................................................... on and I remained his legal wife/husband(Date of marriage)

until his/her death on at and have not since legally or customary married(Date of death) (place of death)

and that my deceased husband /wife has left the following .(Number of Children)

children, the issue of this marriage

Name of child Sex Date of Birth Date of If dead,marriage * # Date of Death

....................................... ............... ................ .................. ....................

....................................... ............... ................ .................. ....................

....................................... ............... ................ .................. ....................

....................................... ............... ................ .................. ....................

....................................... ............... ................ .................. ....................

....................................... ............... ................ .................. ....................

....................................... ............... ................ .................. ....................

....................................... ............... ................ .................. ....................

* If exact date is not known give year in which event occurred.# To be filled in only child is a female .• 2. Whether had any previous marriages, if so,

i. Marriages .ii. Children .

iii. Guardians .A report should be attached

3. I make this solemn declaration conscientiously believing the same to be true.

Date: .(Signature of widow/widower)

•

Witness:-( I ) Signature .

Designation .

(2) Signature .

Designation .

+ Delete which is not applicable.

Name & Address .

Name & Address .

VII

." .

•

•

•

LIFE CERTIFICATE

To Whom It May Concern:

Full name of Pensioner: .

••• ••••••••••• •••••• ••• •••• ••••• ••••••• ••••••••••• •••••• I ••••••••••• "" ••••••••••••••••••••

Pension No.: .

Signature of pensioner: .

I .(Please print name)

Of .(Please print address)

••• I •••••••••••••••••••••••••••••••••••••••••• 1 ••••••••••••• 1 ••• I ••••••••••••••••••••••••••••

(Please state profession)

Hereby certify that .(Please state pensioner's name)

•••••••••••••••••••••••••••••••••••••••••••••••••••• I •••••••••••••• II ••••• I ••••••••••••••••••

Of .

•• 1 •••••••••••• 1. I ••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• I' ••••••••••

Whose signature is affixed above was alive on the day of 2009 .

•

Date . signature .

VIII

..Letter of Consent

This letter of consent is to be submitted by pensioners resident abroad regarding methodof drawing pension.

1.1 Full Name1.2 Neme used for pension

2

3

4

Pension or W&OP No.

3.1 Resident country &Address of pensioner

3.2 Telephone Number3.3 e-mail address

Address in Sri Lanka(if any)

5 Bank Account Number .(Account number at People's Bank - Quean's Branch/Bank of Ceylon - Metropolitan Branch)

Conditions

1. Savings account should be maintained as a single account.2. ATM cards should not be used.3. Subject to the conditions of Director General of Pensions.4. Consent of the Director General of Pensions should be availed to release money

in the account at a situation of paying money to heirs after death of pensioner.5. This account will be used only for crediting pension. Other deposits to this

account will not be accepted.6. Instructions of Pension Circular 16/2009 should be followed to transfer money of

this account to another account.

I declare consent with subject to above conditions to open a savings account at People'sBank, Quean's Branch or Bank of Ceylon, Metropolitan Branch, for pension purposes.

SignatureWitness

1.2.

Recommendations of the Director General of Pensions:-

Signature & Official Stamp

IX

j

Transfer of pension of overseas pensioners to another account

Manager, People's Bank, Quean's Branch, Colombo, Sri Lanka.

Manager, Bank of Ceylon, Metropolitan Branch, Colombo, Sri Lanka.

1. Name of Accountholder:-

2. Foreign Address:-

3. Telephone No.:-

4. e-mail address:-

5. Pension No.:-

6. Bank branch:-

7. Account No.:-

Kindly requested to transfer an amount of Rs. . (by number),

Rupees (in words)

from the special account No which I maintained

to draw the pension to the account No at

................................................. . A duly filled Life Certificate is submitted

herewith.

• Date: .

Signature

x

esJ!;@Je5JJesJo~ecs5eesJut::le5JMANAGER'S INTL

6l!;C;:))O eE:l~J {foesJr:JOFFICER'S SINo

1;.5)~/Date

@~@ {fof:S)r:J/A/C No.

(S,l)(i) {fof:S)r:J/BRANCH No.

I :. ".'~- - -,.~,_.-~::~~~~ - - - - - ;o~:~~o-~:-:~;~~-i:-~~m;-i5)(-~-~-c-)):~~m~;~~::~~:al~~m~)- . PEOPLE'S BANK (2006 {f!ot:5J 6 e6dxJ @@ZJ (5)(2J@jegj] tJJbt:5JJ 638@j@ CH5Jt:5J{f!gj]tJ (f!tJ(5;}ZJt:5JJtJC563)'It (Requirement in terms of Financial Transaction Reporting Act NO.6 of 2006)

PF 0300A S/E Rev. Dec. 2007.e

ee

•

(cr) GeiJJum - crwrnoS3 lil@Gl ~6ml5)m crL(!2~eJ 15lS3g~G.l@GlmGro ~@eiJ GI5lJ6(!26LSection (A) - Basic information of the individual including of those with Power of Attorney

ttt;J(J @CJ)JytJ@ ( "') @&pmJ @c:JJt;eDeD ( "') Tick the appropriate boxes

I. Cll~e~~esJo~ecs5 t::lw~bill:J e5J@JFull Name of the Customer

Cll~e~~esJo~ecs5 @8e5Jc.:lAddress of the Customer

2. ~ZlJeJOec,; E:l~e5JJ~c.:l({f~ernJrn) 3. ~arnffic.:l/cx.ISJc.:lJ~/rnrnrn~c.:l ; INature of business (if any) Occu pation/EmploymenVStatus

4. ~0ill:J rne5Jqjo 5. eE:l~J ec.:lloesJc.:lJecs5e5J@JIPosition held Name of employer

6. ~O~~Se5JJ~c.:l O@@Jo6esJ I 0 t;Elrn~ ~O~~Se5JJ~c.:l t::l6\rn @@JolSJesJI 0 Clet;Cll ~O~~Se5JJ~c.:l t::l6\rn @@Jo6esJ o Elet;iilesJec.:l1:1lCitizenship Sri Lankan Sri Lankan with dual citizenship Sri Lankan with foreign citizenship Foreign national

OJffic.:l 1~t::lJ ~bCllc.:l I IesJ<9@l:1lrn~e5J~e5Jc.:lNationality Type of Visa Expiry date

7. Elet;Cll @8e5Jc.:l({f~ernlrn) IForeign Address (if any)

(qJ) GeiJJum - q'S3eJJOGlOOenlZJeJ/Section (B) - Mandatory Checks(ft;Jt; et:J)}yCJ@( ,;) @~2l'J e"'}t;~ (,;) Tick the appropriate boxes

1. e5J@J.cee55~e5Jc.:lt::lC5lOJffic.:l rn~o~ esJO Cll~Si@J/Name, Date of birth and Nationality verification

~ell ~ell ElbCllc.:l t::l~C5lJ(eC5lrn 1 t::lC5l2) eC5lrn ~elleEle5J 8GCllrn @8 e<9liJe5J~esJell @JCSle55rn~o~ Elc.:l gqjc.:lTo be supported by one of the following accepted documents for each category (1 & 2 below)

0 OJffiesJ C5l~~~@ern 0 C5l@~) Si!; eE:lEl) esJJwrnNational Identity Card Official Armed Forces Service Card 0 eEle5Jrn (ElE:lrno l;.ellEle55e5J)

0 IiJJ@Elc.:lQesJo~Ele55Cl~C5l) coe~e55e5JClC5lffiesJc.:l 0 El\!lt;Cll (l)@Je55liJ@e~c.:l Others (specify)Birth Certificate for minor Passport

2 . @8e5Jc.:laJC5l~O~ esJO Cll~Si@J/Address verification

e~oEl @8e5Jc.:leC5lrn ~elleEle5J 8GCllrn @8 e<9liJe5J~esJell @JCSle55eoell~J esJO aJC5l~O~ esJOCllrngC1)c.:lResidential address verified and supported by one of the following accepted documentso OJffiesJ C5l~~~@eaJ o OOI!lc,; {fwesJJOc.:lISJe55@8c.:lell o eEle5Jrn lll~01:1l(;;lesJJClle5J

National Identity Card Letter from a public authority Statement of other Bankso eJoeC5llCSlesJ~~O05 o {fJ<;)c.:l@1iJ~ @~ern/aJelleE:lo~ ~e55~i o Elet;Cll Cll@Je55liJ@e~c.:l o @lEJe5Jo\(&fulo ~tl"flelle5J)(ElclaJo ~ellEl e5J)Utility Bill (specify) Income Tax ReceipVAssessment Notice Passport Others (Specify)o Oc.:l~O~ lll@~c.:l o I!IE:lElJSigellrn CSl~g@J o 1:1l@CSlElg@JDriving License Employment Contract Tenancy Agreement

* mL@mlCl!1l(!2~. 1 ml5l 2. q'~I5l@ Gluo!ll 8uo!ll "~(ijOI5l sgeJJ" ~~f) m6)l5lf) 6~eJJG.l15l!1l(!2Gl* N.B. Under Item 1 & 2, a copy should be held & stamped "Original Seen"

(!olD@'Ot:D"lD ~(j(J(Jj fI))OID/fJ(JlD)(juJ~/No Mobile phone bills are accepted

3. e~oEl @8e5J\!Ic.:lffiaJ0505Elc.:l: OO~c.:l Status of the Residential Address: Premises

0 6\@esJo~ (1:1) 0 el;.@JJ8c.:le55l!1cs5({fl) 0 lll~/I:1l@ (ff~) 0 Si@ (fft)Owner (A) Parent's (B) Lease/Rent (C) Official (D)

0 @Q)C3e55/e5J~~tC3e55(@) 0 <illiJlaJ@J/e5JElJaJ~e55<ileJ@(0)Friends/Relatives (E) Board/Lodging (F)

elM @8e5Jc.:l/Permanent Address ({f~-O Qillle55(;)ec.:le55/lnthe case of C-F)

4. (;)e5J~ Q~C5l) ffc.:l~@esJo~ec.ll8l@esJ@I/Applicants' ownership of wealtho eeiEJJSesJet;e!; 0 @@Zl El05esJ@ 0 ElZlJeJoesJeO~c.:le55 0 ffJ<ilc.:l\Oe5J 0 <il@\Db 00 o~ (&fulo ~tl"flelle5J)Residential property Financial assets Business premises Investments Motor vehicles Others (Specify)

(<il~e@ f:iJ@/IJJ~ @l0l e5J@esJo,ill:JJeEJe55Q~C5le55esJoe55e5J/ifproperty is on rent/lease, please indicate)

,5. Qell(.') @teQlell @@lQl : Oell(.') @teQlell @lbCSle@lellElII;.? Source of wealth: Wealth generated from

0 El13lelOI:ll B3wl:ll@ 0 CQt@(.') .0 erle(.')!Oell 0 Ela05fD(.')/QU~j(.')lEl 0 eElell05 (~e5OlQ I;.l:lIE>05ell)Business ownership Inheritance Investments Profession/employment Other (Specify)

6. QwQl05(JOl @Elell05El13lelo/Ela05fD(.')I:llDgq)/ Other connected Business/Professional activities

.

erll;.l(.')@Ql!;, @SeCSlI~ erol:ll(.')I [ )Income Tax File No.

7. ~05ElI el;.ell @~e!Vlntroduced by

ell@/Name I@Sell(.')/Address

OlfDl:ll eDt~~@e05 erol:ll(.')/NIC No.

<il~w erol:ll(.')/Account No.

(OoCSl@<il~@ Clf;.eDll;. erElI;.)el)@el;.ell@ I:110CSl05~e~Cll(.')l:lI @Ol ClllQlI 1:ll@@elllI:llQteCllereo@Ol(.')eo~ eElell05 S(.')~@ <il~@ Clf;.eDll;.@@(.')er&lb(.')(.').Mandatory for Current Accounts for all other accounts at the discretion of the Branch Manager on a risk based Approach)

............................................................. .............................................................CSl~el;.~I:llQteCll er05Qell l:,ell(.')Customer Signature Date

Qlt0l:ll i5l@OIOOltelleCll ell@ IName of Bank Officer

............................................................. .............................................................Qlt0l:ll i5l@OlOOltelleCll er05= ~ell(.')Signature of Bank Officer Date

8. I;.el!elll Qtl:ll I:llDgq) I:lle5OlE>l~@tC3e5q)E>1:lleeD! ereJO)el)(.')D@l:lI~ eeJell05@tC3e5q)ElI:llCSl~el;.~I:llQteCll 0 ooeJ 0 elltOlell@ Q~eDel! eJel!eel!l;.?I Does the client appear in the known suspected terrorist list or any other alert list? Yes No

9. CSl~el;.~I:llQt eeD! lil~eCll e~e@ fSlS(.')@Qwe Ql@181:ll(.')1:lle~Cllel@/5) eJClle(.')el!erellleJaOl~ g~CSl@(.')el!I;.? 0 lil~ 0 elltOlIs the client or any member of his immediate family is a Politically Exposed Persons (PEP)? Yes No

lil~ ell@ I:llQt0JlI:llQ ~e50l0 I;.l:lIeJel!ell/lf "YES" - Please Specify

10. eeJell05 ~e5OlQ/erl;.eDe5/QDeDel!(erteOll05) lather Details/Remarks/Notes (if any)

Designed & Printed at People's Bank Printing Section

•..

e--

ee

..•... {5jS]&J !>e>am msOo5' «Jm~5'em ~ffiet»O~~ (5liZ:l~- dtn g~(5)@ CD) Ql~G) GjPEDPLE'S... - lriBIDIllillllri ~JJJiIlJ1uU!liliJlrinlll UIJ&uJiI CIJ'u9itll~ lIi!llll'~~ - 1/iGlJi1lJjWT lDiI~ID <In.L$ · BANKACCOUNT OPENING FORM Savings Accounts - Individual & Joint . ,. ,.

w

~= 0 0 M M V V V V lj)totllCil~ g<!lQIOellQ Qt;./S»)/"'"",J;J~ozir LuSw.,.,i~"@i Ul.,i,tluui/Bank Use Only

iCI"iCI Account I I I IDate Number

l:Dt;@/SJ)l:D6t/(y',. • ..,UlUJ••• 1r/The Manager elF Number

@evo/SJ IiJtotll~/u>';'q,6ir "Jf,;,,J;J/People's Bank 1.

I I....................................................................................................... 2.,&>6li3t'ffiOe~ffi~&D @CilGi/~oeGi ~elI/~~@elI ~elaCl 0000IbW"l Go",~ ,,,,,r.'!>I/6rlD~ ramn",/Q.,wirq,6fiI", SifL/lU4i, ,....,8iQq,.ozir"'jD ~uUil';'''''I';' 3. Manager's IntI.Please open a SAVINGS account in my/our name/ s.

0 QJ@lellI:l/"Ib'u_/Normal 0 Sg ~/5Je; •...Ib••• /Sisu Udana 0 o.lelleQldeiJ@~"/(!J>Ib~ lMo1llI D~(SJ@'Ib<lnj6UiJ 0 O!QeoltD/"''''lAJiJ 4i>1b"';'.Investment savings Individual . Pass Book

0 ~c/~ mwnan~aya 0 QJ@k lj)~/"Ib" UfIIJIlUJUl'I'lWUIb0 Yes ~/Yes,._i.@/YesAcc. o ~Q/e..L.(r;noint 0Normal Minor ~ Cr3JXS>ell/o/Juqi,I1ft$JmJ0 eJ8ItDl !:JlC>eDl/",.IfiIb'<>II'''''' 0 ~~/tiJ"r!!>""Ib"" 0 e&DdJ/GrumJ/Other.................. ;......Vanitha Vasana IsuruUdana (~ ~/~J •••••••/Specify) Statement

(1) !WlC1l0t Q(i)£l) ell@ (@/S)tDl/@/S)~/f!@/S)~/ ..•.............) / (!J>1b'"6T~~" Q.JW'r (~/fJ<!!,tofi/Ge.u.fJ/ •..•••......•..•) / Name with Initials (Mr/Mrs./Miss/ •....._ ....•.)

@@C1lOtEl@elI~elIe&5J ~/CSPIb" 6T~i,e;","", ~~ Q.JW'r,. •• /Names Denoted by Initials

i~ Elbcs:>c/~ ~ ....."./IDType ~ qor=/.-:uw6IT ~ tiJou./ID No. ~O.tll. ~/ •. MI tiJ•• /Tel.No.c0a5 ~6lQ/~1b ,1Je;~/DateofBirth

I I I I I I I I I II IITIITIIIJII~0&=1- _/P_~'Add~

E~~[o<) I I I I I I

0Ul\Q~ <3<Sll~<ll&:> D~ -llj (~h ~ &lU>,!PI ~Initial Deposit ( .) Occupation or Profession

IJ(GJ t!lJi!/lJllfJdl82d86Sf: DtJJf1)d/~,s~ -J#<'5tiuGNfflitHu,mgi/Jolnt Account Holder's Details(2) ~","""l5l(!) (!!JfsxD)/~/~/ __ I/C!P".,~GWr(~IA!!PIJIfd.o.iIl __ ) (3) ~"'""" l5l(!)(!!JfsxD>/~/e&lfu/ __ )/~~~ GWr(~IA!!PIJIfd.o.ti/__ )Name with Initials (Mr/Mrs./Miss/ ...............) Name with Initials (Mr/Mrs.fMiss/ ...............)

j~@'llO' eJ@ffi ~~ ~/c!p~ "~, ••••",,i> ~~ ~/Names Denoted by Initials !il@tllO' ~ ~~ ~/c!p~;" "~I"'''''';''Ibfl~;, GWr •.•• /Names Denoted by Initials

r j~~~ ~~~

I~SlnLtW6l'l' ~ ~".,. &l6nJUT61T ~ ~"""10 Type IDType

•~~ ~/.-um"' •••:.<L ~"" lID No. eoell e.ellCl/~!VJi;1b~,.~/DateofBirth ~~ ~/.-um'" ...:-- ~"" lID No . eoell e.ma>/ 61!VJi;1b~,.~/Date of Birth

1111111= I I I I I I I =JcXlO @&lc/Jf'JJj;Ib~ (!J>"'l.OI/PermanentAddress cXlO @&lc/~iElbu (!J>"'l.Il/PermanentAddress

I

JII

IClttiic>lO••••1 ~.alffico Clttiic>lO••••1 ~.alffico~~.:!J'l.J.'i611 ~' ..••....~ .,..nOccupation or Profession .Occupation or Profession

£:lIllOcDOIll !j)llt6tl Iti'!!l' Cl'l:,lll) Cll!lIJ!l/@i5aiL~ 'nl'uqi 5IUi~~i~ II)LI5Ii>/Only for Investment Savings Account

",telIoo> ~@ (Ot')/"''''lAJi> Glib'''''' (~)/DepositAmount(Rs.)= ........ _-- ...._--_ ......_ .................... __ .........•.....................•.•.................... _-_ ........ _ ...................................................... _ .........._ ............(t:r~/G<>.ti>,..mtMin words)

IllU5Ioo\ tll@9t1l t:rlt:lllOC ~~0

eeQll!llS~

0~ (coc;,«>e\ ",C<ll<o lil~(lj~t:llm@ coa5 e.6lQ/~lDIi>1b~,.~/Date of Birth

m5lJU4i. ",rrrow 1DrJ~lT,r6,.tb 8>lT6lJIJ15'lm1@ GrumJ ~J!JlmfJi.&. 1..J]lItW)6lf)L"61ir.lh6lllIr~ ".•..• ]Deposit Frequency Monthly Quarterly Other ....................... Specify) If Minor Account

• eo~"'@clO ""1ft" ~~"'>S/ft" ~~~ __ /'10 ~ SS!!l ~c! ....................................................................................................................• !lSelI @t;.@ (lJ<'~ @Cill Cll,""'~l (I'''' .oDeodi CD@gq)Q./Q..n(!!'.J:f,f>tO/Jw lffl!>~{)Al ",,11flla..LL (yl~ ntlxtmfQ,"/"~6ir ~61&mr6il""Ji.;7j06m@ U6lIlJribG?:i1Tm",~tO lifo t.MnU taJ;nUuLMlbj"rnlM,6Tr f;;(!?su?6i1 5I~oSl:II}lfAJ" it&~. ~Ii. Guoir6IT6lIw.

Insert "Me persona Iy" /"Both of us" /"Either of us" /" All of us" as appropriately Withdrawals will be made by' .....................................................................................................................

I.1. r::'*otD/ me;Qrnlui>/Signature 2. r::'*otD/ me;Qrnlui>/Signature 3. r::'*otD/ me;Qrnlui>/Signature

I)~ dll/llH IllO4'011llOOdCOGl.!lalalO ~ ~ lll6llllll./utnJ)liIUI~,* &"156 qgfQj DI~f"'a>toi ill'UI'''&-.8lI'tB~U.,; _OIlL ""lIlil5".

If it isa minor Account Guardian's details should be mentionedfoverleaf.Form 506CB EISIT Rev. July 2004

~ ,", ..:. - I. t . . +

r----~~------------- - -----,

• ,..Ill;!! g~Cl)l!l dl~8m1 llllJ,~ ~e. l!lJ !l&! S!l@ ~ !l/;l!lOlJell Qo\l)(Sll!al 544 ~tS\ ~tilClU fI~ eoJ@~ Oa5croflttlleOOl. 5l1t;!le@e<ll1leQ 6J@/fltClU Bl@~!:!l fltQl, ~c! eoJ@t=Cll otliCllO eeo)l!)t&D5l~ e<llaec l!lJeGl BlQl2Sl!:!l~ COtl!)CllOt~ ~ fltQl.&l~Gl dl~@)mI mil, .flo fllllOe5 ~ fl'I!QClJ @Qffi~Cl rn~ e<Il~ &Jlll~ rn~ Bl@OOtCl ee<ll rnlt;!l~ Bl@OO~Cl Bl@ ~eoEJl fltQl.Glm ocmC1m !i11110~O(l8 dl~@)mI mil.OleOl!Q!deo ~6i06\Oe@ rnlt;!ll!l @cllllll!ll:ll ~l!l ClCllleIlOll!=! flt6\ liltoClJBl6l 06\ e:J@ClfI@Cl1@~Cllll 8>6\ 06\ ~@e5 liltt;. S<lW05, ~ Qlte5c:llll ~~@ l!l)Q 60 en enl@QQ Cl)@CDtello05

~. l!ll!l/fl8 l:lltl!lt05eDCellXSl ~/~.iliQl/'liuLL . 1Ji0000aia;rllf''*.jliU'" UlU""Ul"'Ll6lbU"', 6J6U1",jli""L<Y''"'!D';; ~",u.,,,ru Ulm,,! 544 1iiJ'" l'lu"'lI()w @<'!>tflwUl6IlTlbuU"I£iWUl6llTWGl.uiWUuL'-I-Q7l6lbU"'"''''',;;@> tfl!)1!""'" ~"'<,!>';;@> Lmj,lbu@>w. ~oiJ",uiJ)J @<'!>tflwUl6IlTlbUU[r£lWUl6llTWG/QWuJUULrrA!9tf.J>rr5iJ ,f,6llm"8;@}JOiVlffi5lJ 6f6lJr~ "L.L MJrul.tJ/15ar 5Urlfilj.fbrrl]7rl£~i,@, Lfilj,"IT@!D.IJi,.Ll!)ai lJiomai 1JiIiJ; $,"~ililQ;.tiTlDtBdJ 5>(!!J6tlIT ltlI}mTlD6G">Lth;rrsU d>61mf.£@.l J€l2V1m61JLtnir 6lJ1TQ:9w 8>6"mIi@j 61J)511thA!!;UU5lJ(!!Jli.@J ~ruro~ IJimTU,@J 6IJl61Jj,I)(!!;uuruir(f,@!J&@ Lfilj,fb"@}w.l!PiIi.vLI!) CiTul'liljai lJiomailJilllf''*.(!P~~L.@6 ~iEJu4i ih6/JlSli.@J Gl~rrLirurr6ll1 5llP.d~6lir gimL(!pffiW QL.L tfJL.LlliIa;66lriMu~ fDLUUiL!O~. &/mI.fl[i;Gg'"<!£f!fJ6U:'brD@JlD Gwif,@)a5!uliuiuL.L m6lJu4/' Gfbrrma;6IJ)UJ 60 lDllfb g,rr6t)j,~~ 6lJ)5lJlll.,i G<'IW5UfbtD@)W

ID"'"/ 1D"",,,,oirliiJ""ffiI@>Al~!D'"/ 1iiJ""",@>dl\l)lJUw.If an individual Account, .In case of my death, if a nominee has .been appointed by me in accordance with the section 544, of the Civil Procedure Code, he/she will be entitled to the balance in the Account.lfno such nominee is appointed, my legal heirs will be entitled to the balance in the Account.If it's a Joint Account,In the event of death of anyone of us, the surviving account holder/holders will be entitled to the balance.If it's a Investment Savings Account,I/We agree to deposit above amount for sixty (60)months and comply with and to be bound by the Bank's rules for the conductoflnvestment Savings Account.el!)l!) rnlt;!ll!l ~lll~l<!= Qll!l CleJlile5Ol1!Jc.>e5lilt,ClJ eml~eDtrn@e@ Q~b(S)l!llQ tllO flt6\ =/ee<ll e:ncleoJ<3111~mle>l flttil e>"e>c!Cll e<ll eO~@lS l!l1!l/fl8 l!ilClCllI!tI!Ot@mll! lil~ eWe5 Cle<l6\l:ilenOeo flQlO, ~ l!l:ille5e<::S 8smt8>l!lc) 1!ll!l/flO ~Clleil ~@/e~. 'Clo-UJiJ4,;;"''''',;;@> GllbudUl6llT<>'>dJiJ;""6lIUjW,tflu!i;1b"""''''''''6lIUjWjliU"'/jliUw",u6Ji>.tf>JU41i\6.tf>JGl"'u••••.LlbU"'''IW. "''''',;;''''''' ~rnMj,lb,u ~iJ)Jw jli"'L<Y''"')lJiJu(&i>Ib"'Gllbudur'" U>i",oir"""AlI1l", tflUJi;~6Ill•• "'e,;;@>,;;"'L@Uu@"'~!i>@>,IOU"'/jliUW 1iiJ""",@>Al~"'/fiiJ-",@>Al",~w ""'LJ6ll)lblljWliiJi>lbU"' ~16~UI~/~t6~,;;I€1",~uw.1/We hereby certify that 1/We have read & understood the Rules & Regulations of the Bank for the conduct of such Accounts displayed in the Bank Premises and/or included inthe pass book agree to abide by them.

0lBl e<::m@eQClJ !lSe5@6\o l!iloeD/OleoolQldeD rnlt;!ll!lml!lEJaQl l!iloo@l:, Qll!l fl'Bl@QlG:l00t;. eol~enl!QClJ eoll!leoQ Cro@ @tllb e<ltl!ilQ.~I!c! eoJ@tllIIJc.>tlleoll!leoQ tllOell!le5 ~ fll. o. 1510 Cl~bilJ ell@ 9Cl)Cl.I!lil~Ol Blml!l~Cl eo~CllI!Jc.>tlleoll!leDClell@ eeo~tell.~061 jliU[ @<,!>","u,u~UJU4 / <Y'lbIJL(!JiI\':.u'JU4 "'''''',;;@> ~utiJ{j,;;",uu(!JW\':uu$l ~"'[ 1b6llT$l iJ;w6U1(f!>iJUI","'u"'uuw tflwUl6lIllbll()[@<,!>"''''u Glu••• @>£6Ij,,;oJI£IwUJ,;;",,,,mi>.~1li1",uiJ)J j/lUJUlOlrWGl'OOMI1l",~.,.;, 1iiJ"" 1510 III tfluuu ~ ••••.(!Jw.@<'!>Glu"'i>1bUI,;;@>""",Glu!riJ)Ji>Ib"'''''Uu'i,u~"'[ tflWUl6IlT~UU[@<'!>"'''''u tflUJUl"'WGl.uiw <Y'tq.UIT,;oJ.WHEN A SAVINGS ACCOUNT/INVESTMENT SAVINGS ACCOUNT IS OPENED BY AN INDIVIDUAL HE/SHE MAY APPOINT A NOMINEE ON HIS OR HER OWN ACCORD.IN SUCH EVENT HE/SHE SHOULD FILL FORM NO. 1510IN CASE OF A BUDDHIST BIKKHU HE IS NOT ENTITLED TO NOMINATE A PERSONAS HIS NOMINEE.

1. . .m~~CllOt<3csl flo5c:>eo/",rrtq.';;"""'IlJlf",m",",,,,GlIlJlfUuW

Customer's Signature

2 .m~~t:nO<ecsl qo5c:>eo/ "'U'4-';;"""'IlJlf",m","" ••GlUJllUuW

Customer's Signature

3 .mlt;!le~~t:nO<ecsl flo5c:>eo/",utq.';;"''''UIT",ffl", "" ••GlwouuW

Customer's Signature

lil)~eGlm dllil1l!l Q":I5) O€)",m5 o€)lll OllllJDQ Ql!l~~", 1l!l6mm/llrrJ~IIlIDQIlUJrrCili~Ji $ClIl!!iib qgJl'il. jliu(bt'Jllll um;D'$,;' Qnilll6ljIDFill this Section only for the Minor Account

\il(!;)eDClc:.15lI>leo@e5 lill@ e>c>cl (Sg ~, \!)gOI: ~, Clll!lleD!l, O)eDeQ!deo) rnlt;!ll!l1lll~aeD CllOel5eD.(lj~ ISl@ClJecsl ~ c:>&lat>!W!lel!le5 fleoCl)Ot~ lil~ecsl/fI~csl \!)OOl!l 00t;.lil~l!csl/fltQ<llcsl fleDeD"QllEJc.oQl~Ot IIltlllCll!J= Clti?ll!l<J o~ {feoCl)Ote>em!l •• el106leD. ~ e~ rn~~l e>tMCl flEJc!DJ&) ~&l@>C) eoo/og lk:>rnCl ee<ll05 rnlt;!leOl e<ll~rnlt;!ltl ~Jecsl BleD"l@Cl1@COtl!lmlCllO~ ee>eD eCSlllW CllClgCl)CllOel5eD.l!)eodeD liltoClJe!l lill@EJc.oclrnlt;!ll!l1lllc:>Ol~c.>e5 8>til e<ll eo"J@lS fI@fl @Cll /ffiO(Wlll ~JeG08l lilt(. S<ll!lClll! l!)l!) ~ClJC) ~.

~t6iKiL..JjUL.L U(JITll/U)mLlLJT~6lIir QuwIil6i, (IJo; L1b1T6IJf, @ai(!!) L~1T6J:If. "'1T~1T(J6tlaT.c!p~a@q ~WlLfll) 6lI~~i <Ji6lllSJ4Qg;lTlKirmtDt. f.itLJ~ Q",tU.f9l ~IJ!OOli"'6lIlD. ffiJjJ.i. ~mJrei6lf)a; 6lf)61I~tC(!!JUU6'llir UrrlTlU(1)mLJi;~

~e;fJfiIi6lfJa; 6Ul@i.";UU@lD~Ul'J~. &l6Ufill5lir ~6JfmLUJ1f6l1lD @dJ~,f[)1 ~iJ A.!9u~UJmLff,!b a~wiJ ~6U~.$@ u6Wrj,Q!brrma; Gla-tyl~1bUUL ~6U~(3'lD. uurrUJlfi6mL6lJibW@J (JpriuiSlirl ~6Oi6l3lh if>61Jl115.@j m6l1j,A!!;iJu6lJrrliiJiDo.@>WiL'MJ,u, ",,,,,Bi@> """'i>:A!!>uu",ffl ••• Ldiblwrr6llTLmj,lbrr6lil,;;@>",,,,,,;;Al,,, I£i,,'6Ill'" Gl'!)1!j,lbUUL\':"'''';(!Ju,.LDi~6fr 6llrr;,t'ltlildr U!.J1TUJlJ:ImLUJlTtblSlJir<Ji@!l.8;6>n6lll'If,6'mlfi@) jIi6lflL(ylmjI)8- <!JLI_~L~a;tml5l'i'ULll- jIiLUUtb!O@rD. &lm~QJorr~6lJtbtD@JlD ~1T5l'i' i16llN~@I,f;lQH~!Di5!ir.

Please open a Minors Account (Sisu Udana, lsuru Udana, Normal, Investment) in the name of the above mentioned. Payment should be made to the Account Holder at his/herrequest on his/her attaining majority after satisfying yourselves as to the identity of the account holder. In the event of the Account Holder's demise prior to/after attainingmajority the balance in the account should be paid to the legal heirs of the Account Holder.I agree to comply and be bound by the operating rules & regulations of the People's Bank Minor's Account.IISS dll@lS oe>rn~Je= ""S .,@ID/llQeoo ID"tll IICllll5l""dl@,"@ (l<;,t>GlIlrXo "'0 1:I'1i'i .,,,,/ ••,,,1 o)cleol ••rn <;,ml~l fltli'i ~"e>clD) (!;)l eOCil@lS SOl/fiB 6cXll erno,!:lCllol IDE> IIS6rnClISJIi'i", ",0", 1:1"'0, l!l@ e",,/lle<::S BGCllt6'iSCl SOl/fiB ~"'''' ,"~@/,"~@.(;;QuS!U4i <!>6tlllli@ "G,f.iIJ!-J1UIJ&:JJ. 6lfltJ"-'6lO/ilflLjW. ifJutf,fb6!fHlJI&6IfJ/ilflLjtD t&IJ6lIiIfblJW 6lfll!lj,$IU 4filtf,:t>l GlJofT6lllJi-L~1f1Jo6llm. 1f,6llOl'&m", ~!]mU1j,.iJ UlrfJJJJl~ t&mLQP6IfJ!Duu(&~fboU QfbfTLITUIJ6lll wi;w,dr 6lJtt;;,&hUlw!fJurtfbQf'JSSfW,@i.@6; 09iL@UU@6lJ,f,!D@. !6fT0r/tDIJUJ j)6Wl"~@<€IwG!D~/j16Wl"l!il@i1~(;;!DlJm 6TllUiu6ll")fb~tD .@:ifbfTfiJ ~~61'i1&£I51irG:!DIIlir/<9Ir6l6'l'il&&lQjjCi!DfTLO.IIWe hereby certify that IIWe have read & understood the Rules & Regulations of the Bank for the conduct of such Accounts displayed in the Bank Premises and/or included inthe pass book agree to abide by them.

1!Jf!jifu>/ ~uw/Grade

[OJfI:»t;:,/~/Year

ITIJJ

~~w:,~O\ tllC<!!le<::~ } .~E~;;Bt~} .CDI'i\egIlI Clo<!lCll"""~,-j.~ •• @>5'1ItllProduct Code

Designed& Printed at People's BankPrintingSection

For Existing Customers

1. Account No:

2. Name of the Account :

3. Residential/RegisteredStatus of the Residential! Registered Address

Address D Owner D Rent! Lease

D Official D Board! Lodging(Please attach a copy of the recent utility bill D Parents D Others .................

certified by you to prove the residential address.)

4. Correspondence Address(if different to the item No.3)

5. Foreign Address (If any)

6. Nature of the Business /Profession / Vocation

7. Business / office AddressResidence Omce Mobile Fax E-Mail

8. Telephone Number(s)

DD I MM I yyyy9. Date of Birth / Registration

I I Place of Birth

10. NIC No. / Pass Port No.1 Date oflssue

Registration No. (Please attach a coP)' of the NIC / Registration Date of Expirydocument certified by you.)

D Sri Lankan Nationality

11. Citizenship D Sri Lankan with the dual citizenship Type of VisaD Sri Lankan with foreign citizenship

D Foreign national Expiry date

D Business transactions D Savings

12. Purpose oftheAC Opened D Employment! Professional income D Loan repayment

(Tick all relevant boxes) D Inward remittances D Share transactions

D Upkeep offamily / person D Investment purposes

D Domestic necessities D Others (Specify)

Expected source and nature of credits into the accountD Contract! Investment proceeds

13. Source of funds D Sales and business turnover(Tick all relevant boxes) D Family remittances

D Donations/ Charities (Local/ International)

D Commission income D Salary

D Export proceedsD Others (Specify)

14. Tax File No.

15. Anticipated Volumes: D Less than 100,000!~(US$ 1,000) D 2,000,000 to 3,000,000 (US$ 20,000 to 30,000)

Expected / Usual Volumes of D 100,000 to 500,000 (US$ 1,000 to 5,000) D 3,000,000 to 4,000,000 (US$ 30,000 to 40,000)

deposits in rupees / US$ per D 500,000 to 1,000,000 (US$ 5,000 to 10,000) D 4,000,000 to 5,000,000 (US$ 40,000 to 50,000)month: D 1,000,000 to 2,000,000 (US$ 10,000 to 20,000) DOver 5,000,000 - (US$ 50000 - )

16. Spouses Name

• Signature of the Customer

• Date:

l

Bank use OnlyDate:Branch Code:Officer's Sigilature with Sig No :

Kno",YourCustomer (KYC) Profile(Requirement in terms of Financial Transaction Reporting Act No 6 of 2006 )

The ManagerBank of Ceylon

[{] Please Tick the appropriate box / boxes

GRAPHIC SYSTEMS 5333371 - 4

••...•

Dear Customer,

Declaration to be made by customers under the Financial Transaction

Reporting Act. No. 06 of 2006 (FTRA)

Under the provisions of the FTRA No. 06 of 2006 and the rules and regulations

issued by Financial Intelligence Unit (FlU) of the Central Bank of Sri Lanka (CBSL)

Anti money laundering and combating terrorist financing, all banks are required to •

obtain and update the Information of the existing Customers.

In order to comply with this requirement, all banks agreed for a common document

to be forwarded to the Customers. Therefore we are sending herewith Know Your

Customer (KYC) Profile, which is designed to obtain and update the information of

your account.Kindly make arrangements to complete and forward the overleaf format

to your branch accordingly.

•Thank you.

LaUth Fernando

Compliance Officer

Anti Money Laundering

Bank of Ceylon

•

..-.-.•

-IThe ManagerBank of Ceylon

APPLICATIONFor Office Use Only

Branch Code .A/CNo .

ClF NO.1 .

ClF NO.2 .Input by .

Authorized by : .

Pleaseopen an Individual/Joint Account as per details provided below.Please tick 0 the appropriate cage

Manager's Signature Date

•

DOMESTIC CURRENCY ACCOUNTS ""F.OREIGN CURRENCY ACCOUNTS

D Current D Savings D KRG D Savings Specify Currency ...........................................

D Boc Prestige Plus D 18+ D Fixed Deposit D Fixed Deposit *NRFC/RFC/RNNFC/..........................................

D 7 - Day Call Deposit Others ......................................................... Others ......................................... (* Delete whichever is inapplicable)

THE ACCOUNT tSNO.tS, MAINTAINED PRESENTLY OR PREVIOUSLY AT BANK OF CEYLON

D Current D Savings A/C No.' ,(~)................................................................. (ii) ..............................................................

PERSONAL INFORMATION - APPLICANT 1 APPLICANT 2

Title: Mr.lMrs.lMiss/Dr/RevName in Full

Name with Initials

Any other Names(maiden name/others)

Permanent Addressin Sri Lanka with Postal Code

Date Moved to Present Address

Foreign Address(for foreign currency accounts)

Occupation and Start Date

Employer's Name

Official Address with Postal Code

Official Tele.No.Monthly IncomePrevious Employment, if any.

*NIC No.Tax Payer /Tax File No. Yes/No Yes/NoTel No. (Res.)

Tel No. (Overseas)

Fax No.E-mail Address

Nationality

Mailing Address D Permanent D Official D Foreign D Permanent D Official D Foreign

Date of BirthMarital Status

*Passport No.Mobile No.

Signature/s

*photocopy to be attachedD.RANASINGHE & SONS - BOC/SUPP/S 800653

I am well acquai nted with .

whose signature/s appear overleaf and his/her/their signature/s was/were affixed in my presence. I certify that he/she/they is a fare suitable

person/s to open and maintain a Current/Savings Account with Bank of Ceylon.

NCNo. :

Tele No.:

Signature .

Name & Desig nation: .

•

.-For Office Use Address : .

Verified by : .

Signature of the Officer Date .

TIME DEPOSITS Currency

• Cash / Cheque / Draft No .

• Amount (figures) .

In words .

• Term days / months / years

Period From to .

• Rate of Interest % p. a. to be payable

*Monthly / at maturity / at the time of withdrawal

AUTOMATED BANKING SERVICES

• Subject to automatic renewal conditions *with/without interest at the

prevailing rate.• All interest accruing due from time to time should be credited to

*Current / Savings / NRFC Account No of Mr.lMrs.lMiss

.............................................................................at.. Bra nch . (or)

• Mailing address to dispatch the bank cheque for the interest

For Office Use• Receipt No .

(* Delete whichever is inapplicable) •*For Current/NRFC Accounts only(For Automated Banking Services complete relevant application forms)

i*NOMINATION (EXCEPT CURRENT ACCOUNT)

I II I

(1) to .

(2) to .

II

BOC Credit Card ( if any) No. IMobile No. for SMS Banking I

BOC accounts to be linked

-t Bill Nos.

No

NoNo

No

No

No

Yes

Yes

Yes

Yes

Yes

Yes

Visa Electron (Debit)Card

BOC Net

Internet Banking

*Email Statement

SMS Banking

Utility Payment

(*You may omit if you do not wish to nominate.)

Full Name of Nominee

Address of Nominee

ID Card No. / Passport No.If available.

2 3

•Payment %

1/ We do hereby nominate, the abovenamed as my/our nominee/s to receive all monies lying in the account on my/our death subject tothe provisions of Section 14 of Bank of Ceylon Ordinance. We are aware in the event of t,he death of anyone of joint account holders thenomination becomes invalid. Witness:

Name & Address: .

Signature 1 Date: .

Signature 2 Date: Signature

!OPERATING INSTRUCTIONS

• 1/ We agree to comply with and to be bound by the rules of the bank governing the conduct of this account which IlWe have read andunderstood and acknowledge the receipt of a copy of the rules and conditions of the personal/joint accounts.

• For joint accounts - Cheques / Withdrawals will be signed by * 1/ We hereby authorize you to act on instruction givenby * relating to this account (*/nsert both/either of us/anyone/all)

- In the event of the death of anyone of us the balance at credit of the account will be payable to the survivorwithout reference to the representatives of the deceased.

• For foreign currency accounts 1/ We agree to comply with and to be bound by the Exchange Control Regulations & Rules of the Bankgoverning the conduct of this account. •Signature 1 Signature 2

Date Date