KYC Form

PERSONAL DETAILS: Name

Surname

NIC

MARITAL STATUS

SINGLE MARRIED WIDOWED

GENDER

MALE FEMALE

DATE OF BIRTH

PHONE NUMBER

ADDRESS OF RESIDENCE

BANK NAME

BANK ACCOUNT NO.

EMPLOYMENT INFO: JOB TITLE

DEPARTMENT

ADDITIONAL INFO: EMERGENCY CONTACT NAME

EMERGENCY CONTACT NUMBER

RELATIONSHIP

AGREEMENT

I hereby declare that all statement provided above are true and accurate to the best of my knowledge. I understand that this information is for KYC purposes and consent to use information for compliance and regulatory requirement.

KYC Form

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