CITIZENS DEVELOPMENT BUSINESS FINANCE PLC No. 128, Orabipasha Mawatha Colombo-10 CDBd a rosea) emcee ce oe) Co, Rep No, P5220 FIXED DEPOSIT APPLICATION FORM E-mail ozbeetbk pate (oDamevyyy): 16-01-2024 [Type of epost ea Uae Oa Bigot et other pee FReceipt Amount [The Hanager COB 456452 ppicase Open a Fixed deposit account in my our nama! s8y Debit MyiOur COB tet Coe savings account Expected mode of Transactions! Delivery channels ash... Cheque... Fund Transfer... All mode of Forms anh Brancuorzatbn Name with iniats [_PAS?. FERNANDO! Name Denoted by Ina [i PORUTHOTAGE ANTON SHASHIKR PRIVANITA bt Permanent Adorese 1.175, CHILAW ROAD, MANAWERIYA, , KOCHCHIKADE. 2. E-Mail Address 4.shashika.sf@gmall.com 2 NIC No. (1) BorseraEav Date of Binh (1) (03-06-1080 TP.No. (1) rerearTas For sms a @ @ | @ 4 3 8 12 “OnMaturity Monthly Others me =e! ==) | = LL Lo A =e wal oon ES =e r oe a Any one of the Deposit Holders All the deposit holders Signature: change the nominee the depositors must give their consont to obtain a loan against this deposit and Jor to appointccount Hol ser Nomination nes of section S44) () of te Cv Procedure code (Amendment Act No. 14 61093) 1 MINS Miss Date of ith RelatonehipAddress of the Nominee ‘Business Transactions oO investment Purpose [_] Famiy Remitance [_] Employment / Professional Income Family inwards emitance ‘Any creat repayment ‘Social & charity work ‘other (Speci) ‘Source of Funds (Expected source and nature of Credits in tothe account) ‘Sales and Business Tunover Family Remittance Investment Proceeds. Salary iProtessional income Rent / Lease Income Export Proceeds Contract Proceeds Donations /Chartes (Local Foreign) Commission Income Membership Contribution in SalelProft Property Assets ‘ther (Speciy) ‘Less than Re, 50,000 Rs, 50,001 to 100,000 Rs, 100,001 to 250,000 Rs, 250,001 to 500,000, Rs, 500,001 to 1,000,000 Rs. Over 1,000,000 ‘Annual income Less than Rs. 120,000, Rs, 120,001 to Rs. 240,000 Rs. 240,001 to Rs. 360,000, Rs, 360,001 to Rs.600,000 [_] Rs. 600,001 to Rs. 1,200,000 [_] ‘Above Rs. 1,200,000 [_] Ts.the-client or any member of his (her immediate family is a Poltically Exposed Person (PEP)? Yos No [_] tty08, ploase spocity Yes No [_] tyes, ploase specity Low Medium High TERMS AND CONDITIONS 1. Fixed Deposits are not witndrawable before the expiration of the period set out in the Deposit Cetiicate except atthe discretion ofthe management subsequent fo three months notice. 2. Depositors will be notified of maturity ofthe deposit in writing set by ordinary post, at least two weeks prior to maturity 3. Whore the Depositr fais to give the Company seven day's witen notice of intention to withdraw their deposits at matury, such deposits inclusive of Interest wil be automaticaly renewed for the same period at arate of interest prevaling atthe ime of such renewal 4. The depositors wil be required to surender the Deposit Certficate with the endorsement on the reverse to oblain payment ofthe principal sum plus ‘acerued interest. 5. _ In the case of joint deposits unless spectic mention Is made tothe contrary, repayment ofthe capital and or the interest to either party, shall constitute a ful final and complete discharge to the company and the receipt for the payment made by the Company shall be vald good and sufficient as against either ofthe joint depositor. 6. Tre company reserves right to repay deposits without notice, but interest atthe rate set out inthe certificate will be paid tothe depositor forthe period the deposit vemained with the Company. 7. Where @ nomination has been made on a joint deposit such nomination shall be null and void f either of the depostors survive at maturity. 8. Onthe death of a joint holder the company’s liability wil be discharged by payment tothe surviving holders. 9. Onthe death ofa sole holder the company’s liability willbe discharged by payment to the nominee, or the legal ots (inthe absence of a nominee). 10, Any loss or destruction ofthe deposit Certificate should be immediately notified tothe company, supported by an affidavit 11. Any changes to address shoulé be notified to the Company in writing. 12, Company reserves the right to refuse prematurity withdrawals, However may consider such withdr ‘consideration, subject fo reduce rate of interest |LWe do hereby confirm that Uwe received the translation copy of this application contain in my / our prefered language and therefore the information furnished ‘above inthis application and attached annexure's are true and accurate We have read and understood the terms and conditions relating to acceptance and withdrawal of Fixed Deposits. IMVe hereby agree and undertake to abide by them, ras at its sole discretion on sympathetic or other “Accouni Holders Signature “Account Holders Signature Please make the Payment to the nearest Branch and obtain an official receipt. (Office Use Only Introducer Name: Code: ChannelDivision