Irulium Holdings | Investment Application

1. Applicant (Investor) Details

Title

Mr. Mrs. Miss Dr. Rev.

Full Name

Name with Initials

Permanent Address

NIC / Passport Number

Contact Number

Email Address

Occupation

Investment Amount (LKR)

Selected Plan

Payment Option

Monthly Maturity

Date of Commencement

Maturity Date

Bank Name

Branch

Account Number

Full Name

Relationship

Address

NIC / Passport Number

Contact Number

(In the event of the investor's demise, the nominee will receive benefits)

Bank Name

Branch

Account Number

I hereby declare that the information provided above is true and correct. I confirm that I have read and understood all the terms and conditions.

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