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Application Form
Surname
*
Other names
*
Date of birth
*
NIC no.
*
Permanent address
*
Residence Contact no.
Mobile
*
E-mail
*
Occupation
*
Please select the Occupation
Salaried Employee
Self Employed
Small & Medium Enterprises (SME)
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Other
Name of Employer/ Business
*
Lease Type
*
Please select the lease type
Brand New
Unregistered
Registered
Type of Vehicle
*
Please select the type of Vehicle
Car
Van
SUV
Dual Purpose Vehicle
Motorbike
Other
Lease amount
*
Lease period (months)
*
Attach a copy of your NIC
*
Your copy of NIC should be in PNG, JPG, JPEG or PDF format and less than 3MB
Attach last 03 months salary slips
*
Your salary slip should be in PNG, JPG, JPEG or PDF format and less than 3MB
Submit
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