01

No.73/5, Galle Road, Colombo 03, Sri Lanka.Tel: 00 94 11 2 442 442 Call Centre: 00 94 11 2 350 000

APPLICATION FOR FINANCE LEASE FACILITY - PERSONAL epjpf; Fj;jiff;fhd tpz;zg;gg; gbtk; - jdpg;gl;lJl,anÿ myiqlï i`oyd b,a¨ïm;%h - mqoa., $

Notes to the Applicant / b,a¨ïlre úiska ie,lshhq;= lreK /q tpz;zg;gjhuUf;fhd Fwpg;G

Please fill in BLOCK CAPITAL letters meyeos,s w;awl=frka iïmQ¾K lrkaknjspthd vOj;Jf;fspy; epug;gTk;

Please fill in all cages for faster processingjvd;a ld¾hËu fiajdjla i`oyd fuu b,a¨ïm;%fhys ish¨u fldgia iïmQ¾K lrkak' tpiuthd nraw;gLj;jYf;F rfy fl;lq;fisAk; epug;gTk;

For assistance, please contact the Relationship Officer

If necessary, please use extra sheets of paperwjYH kï wu;r lvodis Ndú;d lrkak'Njitg;gbd;> Nkyjpf jhs;fisg; gad;gLj;jTk;

fuu whÿï m;%h iïmQ¾K lsÍug wjYH iyh i`oyd iïnkaëldrl ks,Odßhd yuqjkak'cjtpf;F> njhlh;G cj;jpNah;fj;jFld; njhlh;Gnfhs;sTk;

The Manager,DFCC Bank PLC,

l<ukdlre

ã't*a'iS'iS' nexl=j mS't,a'iS

Kfhikahsu;

b.vg;.rp.rp. tq;fp gp.vy;.rp.

(01) PERSONAL DETAILS / mqoa.,sl f;dr;=re / jdpg;gl;l tpguq;fs;

Full Name (Mr./Mrs./Ms.):(Please underline the surname)

Permanent Address : iaÓr ,smskhepue;ju Kfthp

NIC No. : cd'ye'm wxlhNj.m.m.,y.

Date of Birth : Wmka Èkh

Telephone No. :ÿrl:k wxlh njhiyNgrp ,y.

Email Address :úoHq;a ;eme,a ,smskhkpd;dQ;ry; Kfthp

Correspondence A ddress :,sms yqjudre i`oyd ,smskhfbjj; njhlh;G Kfthp

iïmQ¾K ku ^uhd$ñh$fukúh& ^jdi.u háka brla w`Èkak&

Mobile No. : cx.u ÿrl:k wxlh

Employment Details

/lshdj ms<sn`o úia;r

Profession/Nature of Business : jD;Sh$jHdmdrfha iajNdjhnjhopy;/tpahghuk;

Name and Address of Employer/ Business : fiajd ia:dkfha$jHdmdßl ia:dkfha ku iy ,smskh njhopy; toq;Fehpd;/tpahghuj;jpd; ngah;

Primary Borrower m%d:ñl whÿïlre

gpujhd tpz;zg;gjhuh

Secondary Borrower oaú;Sl whÿïlre

,uz;lhtJ fld; tpz;zg;gjhuh;

KOg; ngau;(jpU./jpUkjp/nry;tp)(gpujhd ngahpd;; fPo; NfhblTk;)

gpwe;j jpfjp

ijj;njhiyNgrp× ,y

njhopy; tpguq;fs;

Employed Since : jD;Sh$jHdmdrh wdrïNl, Èkh njhopiy Muk;gpj;j jpfjp

Branch Name and Code. :YdLdfõ ku yd ixfla;h fpisapd; ngah; kw;Wk; FwpaPL

Date :Èkhjpfjp

Client Type : fiajdodhlhdf.a iajNdjhthbf;ifahsh; tif

NewkjGjpa

Rela�onship Officer : iïnkaëldrl ks,Odßhdf.a kunjhlh;G cj;jpNah;fj;jh;

Employee No. :fiajd wxlhCopah; ,y.

Existingj;aukajw;Nghija

Contact No.(Mobile/Extension) :ÿrl:k wxlh ^cx.u$È.=&njhiyNgrp ,y. (nkhigy;/ePbg;G)

Bank Use Only / nexl=fõ m%fhdackh i`oyd muKs /tq;fpg; ghtidf;F kl;Lk;

02

Finance Required (Rs.) :uQ,H wjYH;dj ^re'&Njitg;gLk; epjp (&.)

(03) FACILITY REQUIRED / wjYH l,anÿ myiqlu / Njitg;gLk; epjp trjp

Lease period (Months) :uq`: f.ùï ld,h ^udi&Fj;jiff; fhyk; (khjq;fs;)

No. of Months Prepaid uq,slj f.jk jdßl m%udKh Kd;nfhLg;gdT khjq;fspd;

vz;zpf;if

+ First Month's Rental =m<uq udifha jdßlh Kjy; khj thlif

Months udikhjq;fs;

Income Details (Rs. Per Month)

udisl wdodhï úia;rh ^remsh,a&

Employment Income : /lshdfjka ,efnk wdodhunjhopy; %y tUkhdk; Interest/Investment Income :

fmd<S/wdfhdack wdodhïtl;b/KjyPl;L tUkhdk;

Other Fixed Income S pecify :

fjk;a iaÒr wdodhï úia;r

olajkak

Total Expenses :

uq¿ úhoïnkhj;j nryT

Net Disposable Income : Yo= Oa jehl, yels wdodhu

nexl= .sKqï ms<sn`o úia;r

ã't*a'iS'iS nexl=j iu`.

Account No..sKqï wxlhfzf;F ,y.

BranchYdLdj

fpis

Recovery Account :

whlsÍï i`oyd .sKqukPl;Gf; fzf;F

Other Accounts :fjk;a .sKqï Vida fzf;Ffs;

Recovery Account :

whlsÍï i`oyd .sKqukPl;Gf; fzf;F

Other Accounts :fjk;a .sKqïVida fzf;Ffs;

khjhe;j tUkhd tpguq;fs; (&.)

Vida epiyahd tUkhdk; (Fwpg;gplTk;)

epfu nrytplf;$ba tUkhdk;:

(02) GENERAL INFORMATION / idudkH f;dr;=re / gpujhd tpz;zg;gjhuh

tq;fpf; fzf;Ffs; gw;wpa tpguq;fs;

b.vg;.rp.rp. tq;fpapy;

Account Type.sKqï j¾.h

fzf;F tif

Account No..sKqï wxlhfzf;F ,y.

BranchYdLdj

fpis

Account Type.sKqï j¾.h

fzf;F tif

Details of Bank Accounts

With DFCC Bank PLC

Secondary Borrower

Details of the Assets j;alï ms<sn`o úia;r nrhj;Jf;fspd; tpguq;fs;

Primary Borrower m%d:ñl whÿïlre gpujhd tpz;zg;gjhuh;

oaú;Sl whÿïlre ,uz;lhtJ tpz;zg;gjhuh;

Condi�on : ;;ajhepiyik

Year of Manufacture/Age :ksYamdÈ; j¾Ih$ld,hcw;gj;jp tUlk;/taJ

Make,Model and Descrip�on : j¾.h" udÈ<sh iy úia;rtif> th;jk kw;Wk; tpguk

Supplier and Country of Origin :ksYamdÈ; rg yd úl=Kqï lretoq;Feh;; kw;Wk; cw;gj;jp ehL

B R U *

(2)(1) (3)

B R U * B R U *

Type of the Assets j;alï j¾.h nrhj;Jf;fspd; tpguq;fs;

*Brand New Re condi�on Used *Brand New Re condi�on Used *Brand New Re condi�on Used

03

Annexure 02 must be completed by personal guarantors mqoa., wemlrejka úiska weuqKqu 02 fmdaruh iïmQ¾K l, hq;=h gpd;dpizg;G 02 jdpg;gl;l gpizahspfspdhy;

epug;gg;gl Ntz;Lk;

NIC No. : cd'ye'm wxlh

Nj.m.m. ,y.

cd'ye'm wxlhNj.m.m. ,y.

cd'ye'm wxlhNj.m.m. ,y.

Telephone Number : ÿrl:k wxlhnjhiyNgrp ,y.

(04) DETAILS OF PROPOSED GUARANTORS / fhdacs; mqoa., wemlrejkaf.a f;dr;=re / cj;Njr gpizahspfspd; tpguq;fs;

Name :

Address: ,smskh

Kfthp

(2)(1) (3)

kungah;

(05) DECLARATION / .kqfokqlref.a m%ldYh / gpufldk;

I/We declare that the information furnished in this application and attachments is true and warrant that I/we have made full disclosure of all matters relevant in any way whatsoever. I/We agree that any material error, omission or misrepresentation will give DFCC Bank PLC the right to cancel the lease facility and to demand and recover payment of all its claims on the company/lessee. I/We authorise you to make any inquiries you deem necessary for credit assessment or confirmation of the above particulars from financial institutions, auditors or any other party.

Name :ku

ngah;

Name :ku

ngah;

NIC No :

(06) CHECK LIST / msßlaiqï ,ehsia;=j / rhpghh;g;Gg; gl;bay;

1. Performa invoice(s) of the asset(s) to be leased

2. (if second hand/recondi�oned unit)

3. Income tax r eturns of borrower and guarantors (Covering the last 3 years)

4. Bank statements covering the last 6 months

5. NIC copies of borrower and guarantors

6. Any other relevant documents

(please specify)

NIC No :

m%d:ñl whÿïlref.a w;aik gpujhd tpz;zg;gjhuhpd; ifnahg;gk;

,uz;lhtJ tpz;zg;gjhuhpd; ifnahg;gk;

Submi�ed by the Client whÿïlre úiska imhd we;thbf;ifahsh; rkh;g;gpj;jJ

Requested by DFCC Bank PLCã't*a'iS'iS' nexl=j úiska b,a,d we;b.vg;.rp.rp. tq;fp gp.vy;.rp. NfhUtJ

l,anÿ l, hq;= jia;=j$j;alïj, ld¾h idOk bkafjdhsishFj;jiff;Fg; ngWk; nrhj;jpd; (nrhj;Jf;fspd;) g+h;thq;f tpiyg;gl;bay;(fs;)

epiyik/ngWkjp kjpg;gPl;L mwpf;if(fs;) (gioa/Gduikf;fg;gl;l cgfuznkdpd;)

Ndú;d lrk ,o $w¨;a jeähd lrk ,o tallhla kï ;lafiare jd¾;dj

fldhsp kw;Wk; gpizahspfspd; tUkhd thpg;gj;jpuq;fs; (filrp 3 Mz;LfSf;Fhpait)

filrp 6 khjq;fSf;fhd tq;fp tpguf;$w;Wfs;

Kh .eKqïlrejkaf.a iy wemlrejkaf.a wdodhï nÿ m%;s,dN ^miq.sh jir 3 wdjrKh&

miq.sh udi 6l nexl= m%ldY

fldhsp kw;Wk; gpizahspfspd; Nj.m.m. gpujpfs;Kh .eKqïlrejkaf.a iy wemlrejkaf.a cd;sl ye`ÿkqïm;a msgm;a

NtNwJk; nghUj;jkhd Mtzq;fs; (jaTnra;J tpghpf;fTk; )fjk;a f,aLk - ^lreKdlr i`oyka lrkak&'

,e;j tpz;zg;gj;jpYk; ,izg;Gf;fspYk; toq;fg;gl;Ls;s jfty;fs; cz;ikahdit vdTk; VNjDk; tifapy; njhlh;Gila rfy tplaq;fSk; ntspg;gLj;jg;gl;Ls;sd

vdTk; ehd;/ehk; cWjpaspf;fpNwd/cWjpaspf;fpNwhk;. VNjDk; Kf;fpa jtWfs;> tpLgLiffs; my;yJ jtwhd tpghpg;Gf;fs; ,Uf;Fkhapd;> ,e;jf; Fj;jif trjpia

,uj;Jr;nra;aTk;> fk;gdpaplk;/Fj;jifjhuhplk; ,Ue;J rfy nfhLg;gdTfisAk; Nfhhp kPl;Lf;nfhs;sTk; b.vg;.rp.rp. tq;fp gp.vy;.rp. chpik nfhz;Ls;sJ vd;gij ehd;/ehk; Vw;Wf;nfhs;fpNwd;/Vw;Wf;nfhs;fpNwhk;. fld; jFjp kjpg;gPL my;yJ NkYs;s tpgguq;fspd; Ch;[pjg;gLj;jYf;F mtrpankd ePq;fs; fUjpdhy; epjp epWtdq;fs;> fzf;fha;thsh;fs; my;yJ NtNwJk; jug;gpdhplk;

VNjDk; tprhuizfis Nkw;nfhs;s ehd;/ehk; cq;fSf;F mjpfhuk; mspf;fpNwd;/mspf;fpNwhk;.

fuu ,Sisx myiqlu iïnkaOfhka isÿ flfrk Kh fhda.H;d we.hSug yd by;ska we;s f;dr;=re ;yjqre lr .ekSug ´kEu uQ,H fyda ú.Kk wdh;khlska úuiSï isÿ lsÍug fuhska udf.a $wmf.a wjirh ,nd foñ$ fouq'ud$ wm úiska by; imhd we;s f;dr;=re i;H yd ksjerÈ nj;a" wod< ish¨ f;dr;=re whÿïmf;ys i|yka fldg we;s nj;a m%ldY lrñ$lruq' hïlsis je/oaola" f;dr;=re ieÕùula fyda úlD;s lsÍula ud$wm w;ska isÿù we;s kï fuu ,Sisx myiqlu wfydaiS lsÍfï n,h iy thg wod, whúh hq;= uqo,a i|yd ysñlï mEug DFCC nexl=jg fuhska n,h ,nd foñ$

fouq.

Signature of the Primary Borrower

Signature of the Secondary Borroweroaú;Sl whÿïlref.a w;aik

Condi�on/valua�on report(s)

SR

P G

RAP

HIC

FO

RM

NO

. 010

2002

6 V2

.0