Name*     Email Address*     Age*     Are you employed Salaried Self-Employed     Level of Employment Govn.Servent Senior Manager Professional Director/CEO Manager Businessman Executive Other     Nationality Sri LankanOther         Country of Residence Sri Lanka Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antartica Antigua ; Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Botswana Bouvet Island Brazil Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Chad Chile China Christmas Island Cocos Columbia Comoros Congo Congo, Dem. Repub. Of Cook Islands Costa Rica Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Ecuador Estonia Egypt El Salvador Eritrea Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Ivory Coast Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea (North) Korea (South) Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nepal Naura Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Isl Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Repubblic Of Nagorno Karabakh Reunion Romania Russian Federation Rwanda S Georgia ; S Sandwi Saint Kitts ; Nevis Saint Lucia Saint Vincent ; Gren Samoa San Marino Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovak Republic Slovenia Solomon Islands Somalia South Africa Spain St Helena Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo TTokelau Tongo Tunisia Turkey Turkmenistan Turks ; Caicos Islan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Us Virgin Islands Uruguay Uzbekistan Vanuatu Vatican City State Venezuela Vietnam Western Sahara Yemen Yugoslavia Zaire Zambia Zimbabwe     Net Monthly Income* USD GBP AUD EUR LKR     Other Monthly Income*     Are you Married Yes No     How many children do you have None1-3More than 4     Do you own a house Yes No     Do you own a car Yes No

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