Serendib Stock Brokers (Private) Limited No. 156,3 rd Floor, Walukarama Road, Colombo 03. Tel: 011 2565635 Fax: 011 2565604 E mail: info@serendibsb.com KNOW YOUR CUSTOMER (KYC) PROFILE (For Individuals) This information is sought under the Prevention of Money Laundering Act No.6 of 2005, Financial Transaction Reporting Act No.6 of 2006 and the Rules for the Securities Industry issued by the Financial Intelligence unit of the Central Bank of Sri Lanka. Please tick the appropriate box / boxes. Client Type: Individual Joint PERSONAL DETAILS Primary Applicant Joint Applicant Full Name( Mr./Mrs./Miss/Dr./Rev.) : Full Name (Mr./Mrs./Miss/Dr./Rev.) :............ NIC/PP No: NIC/PP No:... Address:.. Address:........... Contact Details Contact Details Office:. Mobile:.... Office:...... Mobile:...... Residence:... Fax:.. Residence:...... Fax:... E mail: E mail:.. Status of Residency Address: (Premises) Owner Lease/ Rent Parent s Friends/Relatives Official Board/ Lodging Other Specify. Preferred form of Communication Telephone Mobile Letter Email Fax EMPLOYMENT DETAILS Employees Occupation:.... Name of the Organisation:. Address of the Organisation:. Self Employed / Professionals Nature of Business / Profession:. Registered Address..:.....:...... BANK DETAILS (RESIDENTS ONLY) Do you wish the firm to deposit your sales proceeds to your Bank Account? Yes No If yes, Savings/Current A/C No:. Name of the Bank:. 1
Branch Address:.. 2
INVESTMENT OBJECTIVES I accept a low risk in order to achieve a profit I accept a calculable risk in order to achieve a profit I have a higher profit expectation and I am willing to accept an appropriately higher risk I have a high profit expectation and I am willing to accept a high level of risk I have a high profit expectation and accept a very high risk. (*Please note that the higher the level of risk, greater the chance of a total loss.) Investment Experience Yes No If Yes, length of Experience Less than 6 months 6 months to 2 Years More than 2 Years Preferred Investment Horizon Up to 1 Year 1 to 3 Years More than 3 years Expected Value of Investment per annum (Rs.) Rs. Less than 100,000 Rs. 100,000 to Rs.500,000 Rs. 500,000 to Rs.1,000,000 Rs.1,000,000 to Rs.2,000,000 Rs. 2,000,000 to Rs.3,000,000 Rs. 3,000,000 to Rs.4,000,000 Rs.4,000,000 to Rs.5,000,000 Rs. 5,000,000 to Rs.10,000,000 Over Rs. 10,000,000 SOURCES OF FUNDS Sales and business turnover Contract proceeds Investment Proceeds/Savings Sale of Property / Assets Gift Membership Contribution Commission Income Family remittances Export Proceeds Salary Profit Income Donations/Charities (local/foreign) Others (Specify). Gross Annual Income from all sources (Optional) Up to Rs.500,000 Rs. 1 Million Rs.2 Million Above 3 Million Rs.500,000 Rs. 1 Million Rs. 2 Million Rs.3 Million Other Connected Business / Professional activities & business Interests: Other details / Remarks/ Notes (if any) :... 3
AUTHORISED TO HOLD SALES PROCEEDS TO MEET THE SETTLEMENT OF FUTURE PURCHASES Yes No MARKETING We would like to give you information about products and services offered by other Companies in our Group (together the Group ) or selected parties whom we believe may be of interest to you. We may also disclose information to other Group Companies or third parties to enable them to contact you directly for these purposes. Wish to receive information concerning products or services offered by the Group Wish to receive information concerning products or services offered by third parties Do not want to receive information concerning products or services offered by the Group Do not want to receive information concerning products or services offered by third parties NEXT OF KIN In the name of Account holder, the nominee shall be entitled to receive securities/ cash available in the account of the account holder after set off against losses/liabilities in the account. I wish to appoint a nominee Yes No If Yes, please provide the details of the nominee. Full Name: Relationship with Account Holder: Nationality: NIC/PP No: Address: Telephone (Office/Residence) :..........E mail:.. HOW DID YOU LEARN ABOUT SERENDIB STOCK BROKERS (PVT) LIMITED? TV Advertisement Print Advertisement Referred by Serendib Customer Other (Please Specify) REASON FOR OPENING AN ACCOUNT WITH SERENDIB STOCK BROKERS (PVT) LTD Good Image Quality/ Efficient Service Friendly Staff Convenient location Other (Please Specify).. 4
Client Declaration I / We do hereby jointly and severally confirm and declare, that I / We have read and clearly understood the conditions of sale and the regulations made there under stipulated by the Colombo Stock Exchange (as may be amended from time to time) governing transactions, which I / We will be entering in to with Serendib Stock Brokers (Pvt) Ltd. I /We hereby agree to abide by the said conditions of sale. I / We do hereby further jointly and severally declare and confirm that I / We have clearly understood the regulations stipulated in the aforesaid conditions of sale (and any amendments made from thereto from time to time) governing defaulted contracts and do hereby authorize and permit Serendib Stock Brokers (Pvt) Ltd to sell the shares, debentures and Govt. securities pertaining to the defaulted contracts (which shall be done with notification to and under the supervision of the Colombo Stock Exchange) but also any other shares, debentures, and Govt. securities fully paid for by me / us, line in my / our CDS account /s in order to enable them to recover monies due to them including interest, penalties and other charges in the event of my / our not paying inability to pay for the shares, Govt. securities and debentures transacted through Serendib Stock Brokers (Pvt) Ltd. I / We do hereby jointly and severally further acknowledge and confirm that authority expressed herewith shall constitute a mandate given by me / us in favor of Serendib Stock Brokers (Pvt) Ltd. to have access to additional shares, debentures and Govt. securities held by me / us in my / our CDS account / s with Serendib Stock Brokers (Pvt) Ltd. as the lodging agent. I / We undertake to deposit with Serendib Stock Brokers (Pvt) Ltd. along with any purchase order, a sum not less than (50%) of the estimated market value of such purchases as at the date of the purchase order, which said sum is to be set off against the total amount due from me / us on the date of settlement in respect of such purchase. I / We jointly and severally further acknowledge agree and confirm that I / We shall be liable to Serendib Stock Brokers (Pvt) Ltd. for any and all loss sustained or incurred in relation to any direct transaction carried out by Serendib Stock Brokers (Pvt) Ltd. for and on my / our behalf (in it s capacity as selling / buying and / or in relation to dividends rights bonuses and other benefits attached to the share, debenture and Govt. securities) and do hereby agree to indemnify Serendib Stock Brokers (Pvt) Ltd. against such loss or damage arising therefore. I / We do hereby further jointly and severally declare and confirm that the securities handed over by me / us to be lodged in this account are genuine and that I / we have absolute legal entitlement to transfer to CDS title in the said securities. 5
I / We hereby request Serendib Stock Brokers (Pvt) Ltd. to accept and to execute instructions and to give effect to requests to the Company to enter into contracts with or for me / us of any other nature whatsoever where such instructions and / or request are given :- By telephone, telegram, telex or electronic recording and purport to come from me / us and are honestly believed by the Company to come from me / us, even if not in fact coming from me / us and / or not followed by written confirmation. I / We declare that we shall not hold Serendib Stock Brokers (Pvt) Ltd, responsible for the non-execution of any order placed by me / us, if such orders could not be executed despite the exercise of due care and diligence by Serendib Stock Brokers (Pvt) Ltd. No discretionary powers will be given by me / us to any employees of Serendib Stock Brokers (Pvt) Ltd. without the written confirmation of same from Serendib Stock Brokers (Pvt) Ltd. Any document, addressed to me / our last known address and sent by courier or by post shall be deemed to be has been received by me / us on the day it would have been delivered in the normal course of business. I / We do hereby further jointly and severally declare and confirm that the securities to be purchased through the CDS account would be for the benefit of mine / our s only, and for no other beneficial owner / s. I / We do hereby further jointly and severally declare and confirm that the monetary funds to be invested through the CDS are funds not generated from any money laundering activities nor funds generated through the financing of terrorist or any other illegal activities. I / We do hereby further jointly and severally declare and confirm that in the event of a variation of the information submitted to CDS (CDS Form 1), I / We would inform the CDS, in writing within 14 days of such change. Any amendments or modifications in respect of this Agreement will be effective if notified by Serendib Stock Brokers (Pvt) Ltd. in writing to me / us and shall be then deemed to have been accepted by me / us. 6
I / We abide by the terms and conditions of the client declaration and agree to bond by same. I / We hereby declare that all the information given in the Client Registration Form (For Individuals) Part 1 & Part 2 and the Know Your Customer Form is true and accurate, and that no alteration, modification was made to the said information to hide or reflect true facts. ----------------------------------------------------------- --------------------------------------------------- ------------------------- Name (Principal Applicant) Signature Date ----------------------------------------------------------- --------------------------------------------------- ------------------------- Name (2 nd Joint Applicant) Signature Date ----------------------------------------------------------- --------------------------------------------------- ------------------------- Name (3 rd Joint Applicant) Signature Date For Official use only Client Introduced by :-... Employee Number :- Agent Code:-.. Application Received on :- Signature :-..... Approved by :-..... Compliance Officer :- Date :-... 7