Know Your Customer (KYC) Profile Form (Individual / Joint)

Know Your Customer (KYC) Profile Form(Individual/Joint)

(Requirement in terms of Financial Transaction Reporting Act No 6 of 2006)

DATE :

A/C NO :

BRANCH NO :

OFFICER NO :

SIGNATURE :

(Branch Manager/Assistant Manager/Head of Department)

Section A – Basic information of the individual including of those with Power of Attorney

✓ Tick the appropriate boxes

1. Name in full:

2. Date of Birth:

3. Nature of business :

4. Occupation/Employment/Status:

5. Name & Address of Employer :

6. Position held:

( Director/Partner/Major Shareholder/Office Bearer etc.)

7. Citizenship :

 Sri Lankan

 Sri Lankan with dual citizenship

 Sri Lankan with foreign citizenship

 Foreign national

Nationality

Type of Visa

Expiry date

8. Foreign Address (if any):

Section B -Mandatory Checks

✓ Tick the appropriate boxes

1. Name, Date of birth and Nationality verification:

To be supported by one of the following accepted documents

 National Identity Card No (……………………….)

 Valid Passport No (…………………….)

 Postal Identity/Birth Certificate for minor (…………………)

 Valid Driving License No (…………………….)

 Others(specify)

2. Address verification: Residential address verified and supported by one of the following accepted documents

(N.B.- Mobile Phones Bills are not accepted)

 National Identity Card

 Tenancy Agreement

 Valid Driving License

 Utility Bill not over three months’ old

(Electricity/Water/Fixed Phone)

 Employment Contract

 Income Tax Receipt/ Assessment Notice

 Letter from a public Authority

 Others (Specify)

N.B.- Under item 1 & 2, a copy should be held & stamped “Original Seen”

3. Status of the Residential Address: : Premises

 Owner

 Parent’s

 Lease/Rent

 Official

 Friends/Relatives

 Board/Lodging

Permanent Address:

4. Geographical Area:

Customer is residing within a reasonable distance to the Branch? Yes No

If not the Reason for opening an account at the branch :

5. Applicants’ Ownership of Wealth and Estimated Value:

 Residential property

 Business premises

 Motor vehicles

 Financial assets

 Investments

 Others (Specify)

(If property is on rent/lease, please indicate)

6. Source of Wealth : Wealth generated from

 Business ownership

 Investments

 Profession/employment

 Inheritance

 Others (specify)

Information & Account Profile Form

1. A/C Type

 Savings A/c

 Current A/c

 Fixed/Call Deposit A/c

 Money Market A/c

 Treasury Bill/Bonds

 Foreign Currency A/c

 Others (Specify)

2. Purpose for opening the account & the usage

 Business transactions

 Salary/Professional income

 Remittances

 Bill payment/Loan repayment

 Savings

 Share transactions

 Investment purposes

 Donations/Charities(Local/Foreign)

 Others (Specify)

3. In case of Foreign Passport Holders, give the purpose of opening the account in the foreign jurisdiction:

4. Source of Funds:

Expected source and nature of credits into the account

 Sales and business turnover

 Family remittances

 Rent Income/Commission Income

 Export Proceeds

 Contract proceeds

 Donations/Charities (Local/Foreign)

 Salary/Profit/Professional Income

 Investment Proceed

 Sale of Property/Assets

 Gift

 Membership Contribution

 Others (Specify)

5. Expected Monthly Turnover :

Expected/Usual average volumes of deposits into the account in Rs per month

 Less than Rs. 50,000 (or equivalent FC value)

 Rs. 50,000 to Rs. 100,000 (or equivalent FC value)

 Rs. 100,000 to Rs. 500,000 (or equivalent FC value)

 Rs. 500,000 to Rs. 1,000,000 (or equivalent FC value)

 Rs. 1,000,000 to Rs. 5,000,000(or equivalent FC value)

 Above Rs. 5,000,000 (or equivalent FC value)

6. Expected Mode of Transactions/ Delivery Channels :

 Cash

 Cheques

 Fund Transfers

 Remittances

 Others (Specify)

7. Other Connected Business/Professional activities & interests

8. Expected Types of Counterparties (if applicable)

9. Are you or your close relative a Political Exposed Persons (PEP)?

If “YES”- Please Specify :

Yes



10. Other Details/Remarks/Notes (if any):

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………………………………. … …….......……………

Signature of Applicant Date

FOR BANK USE ONLY

Account Number :

….………………………………. ……………………………………………………. ………………………….

Signature of Authorized Officer Name Date