SENKADAGALA FINANCE

Application to open a Deposit Account

NOTE : Please read the Terms and Conditions before filling out this form.

(*) marked are mandatory fields and must be filled

Deposit Amount (Rs)*

Full Name*

Address*

Telephone Number

Identity Card No.*

Passport No.

Declaration By Depositor

Income Tax File No.

Tax Direction No.

TO BE TICKED ONLY IF YOU ARE NOT LIABLE TO INCOME TAX
I/We hereby confirm that I am/We are not liable for the payment of Income Tax on the
Above deposit. Please therefore refrain from deducting the withholding Tax from the interest due to me/us thereon.

I am/We are not liable for the payment of Income Tax

Term of Deposit*

Years

Interest Rate*

Interest to be Paid

Monthly

Quarterly

Person/Persons to whom interest is to paid if other than depositor/depositors

Name

Address

Person/Person’s nominated to receive repayment of deposit/s where such Person/Persons is/are other than the depositor/depositors

Name

Address

I/We hereby instruct the Company to remit the interest by ordinary post to the above address/to my Bank

Account No

Bank

Branch