Wealthplus Investment Pvt Ltd
Business Reg No: PV-00241512
Office: 328/2, Kirillawala, Imbulgoda, Kadawatha, Sri Lanka

LEASING APPLICATION FORM

Instructions:
1. Complete all sections in BLOCK capitals.
2. Attach copies of NIC/Passport, salary slips (last 3 months), and utility bill.
3. Submit completed form via the callback request panel or visit our office.

---
SECTION A: PERSONAL DETAILS
Full Name: __________________________________________________
NIC Number: ___________________ Date of Birth: _______________
Residential Address: _________________________________________
Contact Number: _________________ Email: _____________________

SECTION B: LEASE DETAILS
Vehicle Make & Model: ________________________________________
Year of Manufacture: ___________ Purchase Price: LKR __________
Requested Lease Amount: LKR ____________ Period (Months): _____

SECTION C: EMPLOYMENT / INCOME DETAILS
Occupation / Designation: ____________________________________
Employer Name & Address: _____________________________________
Monthly Basic Salary: LKR ___________ Other Income: LKR ________

I hereby declare that the details provided above are true and accurate.

Signature of Applicant: ___________________ Date: ______________