Form 1

LankaSecureNet CONFIDENTIAL

APPLICATION FOR INDIVIDUAL INVESTORS

Section A - Details of the Applicant/s

1. Full Name: i). Mr./Mrs./Miss/Rev : Mrs.Sandya Ebrt
ii). Mr./Mrs./Miss/Rev ......................................................................................................
2. Address: i)No.56/8 , 6th pope poul MW, Negombo.
ii)...........................................................................................................................................
3. Date of Birth: i)1667/04/09
ii) .................................
4. Residence i) Telephone: 0777362259 E mail: amarasiri.daluwatta@gmail.com
ii)Telephone: ............................... E mail: ..........................................
Office i)Telephone: ..............….............. E mail: .........................................
ii) Telephone: .............................. E mail: .........................................
5. NIC i)676002561v ii).............. ...........................
Passport i)......................................... ii).........................................
Driving License i)......................................... ii).........................................
6. Mother's Maiden Name: i) Reta Fernando ii)...................................................
(We required for identification of telephone caller)

We declare that the above information is true and correct and we have read and understood
the terms and conditions and agree to abide by them.
iSandya

ii).........................................
2023/06/25
Date: Signature of Applicant/s

Section B - Details of Account/s (To be completed by Participant/s

who maintain/s security account/s on behalf of the
applicants)

a) Name of the Participant: .................................................................................................

b) BIC: ......................................................
c) Beneficial Owner/s ( Customer)Code: ......................................
d) Names of the Beneficial Owners i)................................................................................
ii)………………………………………….................
e) Address: i).....................................................................................................................
ii)....................................................................................................................
f) Additional Owner/s Code: ................................

We certify that the above information is true and correct according to our records.

Authorized Officer
Date (Official Stamp)
 Form 1 (A)
AGREEMENT FOR LANKASECURENET -
TERMS AND CONDITIONS

The Monetary Board of the Central Bank of Sri Lanka,

Central Bank of Sri Lanka,
P.O.Box 590,
Colombo 01.

Dear Sir/ Madam,

I/We.........................................................................................................……………………… of ..............................................................
........................................................................................................ request you to issue me/us a User Identification Number (User
ID) and allow me/us the use LankaSecureNet, Internet Based Account Verification Facility and hereby agree to be bound by
the following terms and conditions:

1. Facility have absolute discretion to change, vary, add or

I/We acknowledge and accept that the facility available to amend these privilages and conditions attached
me/us under this agreement is to view my/our personal thereto, from time to time as the
scripless securities account in the central depositary LankaSecureNet deems necessary.
system of the Central Bank of Sri Lanka through the use c) LankaSecureNet may time to time introduce
of operational instructions as contained in the user guide new facilities/options into LankaSecureNet
annexed hereto. service. I/We hereby agree to abide by the terms
and conditions applicable to such newly added
2. Responsibilities for Security. services, facilities/options though added
a) I/We agree to duly acknowledge the receipt of subsequently to the activation of the User IDs
my/our Password and also agree to retain my/our whether or not I/We register myself/ourselves to
User ID in disabled status till LankaSecureNet avail such services.
receives proper acknowledgement of receipt of
the password by me/us.
b) I/We undertake not to access LankaSecureNet 4. Indemnity
using defective or insecure equipment or in any I/We do hereby agree and save harmless against
manner which might adversely affect any losses, charges, expenses and damages that
LankaSecureNet. LankaSecure shall or may be caused or sustain
c) I/We hereby agree to change the password incurr or suffer by reasons of my/our using
assigned to me/us immediately after accessing LankaSecureNet in any manner whatsoever and
LankaSecureNet for the first time and at regular for any loss and/or misdirection of data in transit
intervals thereafter. electronically and by reasons of LankaSecure
d) I/We shall inform LankaSecureNet immediately if generating and/or issuing and/or dispatching the
I/we become aware of any unauthorized access to original password/s according to my/our requests
or use of the User ID and Passwords by anyone. and/or subsequent passwords to my/our User ID,
I/We acknowledge that the Monetary Board of the at my/our written request and any substitution
Central Bank of Sri Lanka shall not be liable for effected by me/us or by reason of access to my/our
any loss or damage that I/we may suffer on password or ID number by any person other than
account of any unauthorized use of my/our User me/us.
ID and Password.
e) I/We shall keep my/our User ID and Password
strictly confidential and undertake not to reveal 5. Governing law
them to any person at anytime or under any This agreement shall be governed and construed
circumstances. in accordance with the laws of Sri Lanka.
f) I/We shall keep all information, techniques, data
and designs relating to LankaSecureNet
completely confidential. I/We shall not disclose I/We have read and understood the forgoing and
any of them to any other party. agree to be bound by the above terms and
g) My/Our obligations relating to confidentiality will conditions and the Indemnity.
continue indefinitely. They will not end with the
expiry or termination of this agreement.
i)Sandya

3. Changing the Terms and Conditions.

a) LankaSecureNet shall at any time be entitled to ii)
amend, supplement or vary any of these terms 2023/06/25
and conditions at its absolute discretion with or Date Signature/s
without notice to me/us and such amendment
supplement or variation shall be binding on
me/us.
b) LankaSecureNet shall determine the previleges
attached to the use of LankaSecureNet and shall