Welcome To Seylan Merchant Bank



Application for your Ayu Fixed Deposits


First/Sole Applicant
Title
*First Name/Company Name:
Last Name:
Date of Birth:	dd/mm/yyyy
*NIC/DL/PP/BRC No:
Contact No:
*E-mail Address:
*Residential Address:

Joint Applicant (If applicable)
Title:
First Name/Company Name:
Last Name:
Date of Birth:	dd/mm/yyyy
NIC/DL/PP/BRC No:
Contact No:
E-mail Address:
Residential Address:

Nominee Details:
Title:
Name in full:
NIC/DL/PP No:
E-mail Address:
Residential Address:

Investment information
*Investment Amount (LKR):	(type numbers only)
*Period of Investment in months

Payee Details By ordinary mail
Name
Remit to Bank Account
Name of the Bank
Branch
Account type:
Bank Account No:

Operation Instructions
For Withdrawals:
For Reinvestment Capital + Return:
For Payment of return at maturity:


This information is needed to help us to personalise our reply according to your needs. Investment Certificates are accepted for above RS. 250,000.00 amount of investments.