APPLICATION FORM FOR REFERRAL AGENT REGISTRATION
(EMPLOYEES)
All fields marked with * are Mandatory | Please fill up the form using BLOCK LETTERS
Employees are required to fill separate form
AGENT DETAILS *
1. Referral Agent Identification Number
:*
2. Name with Initials
:*
3. Address
:*
4. NIC/Passport No
:*
MKYC NOKALAL
6. Name and employee no of the relative (if applicable) : *
CONTACT DETAILS *
Mobile
:*
Email
:*
BANK DETAILS *
Bank
:*
PEOPLES BANK
Branch
:*
PANADURA
Account No
:*
CONFIRMATION *
I do hereby certify that the particulars furnished by me in this application are true and correct.
Name
:
MKYC
Signature:
Date
: 2024/05/29
Note: This form to be submitted along with supporting documents of NIC/Passport and Bank Passbook / statement