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i'o wo arom!-{ ftfr-sBAI{K OF XATHMANDU LTD.
- lRAnnex - 12
(faffiq Ro {Tr {qftrdr(Pursant to Byelaw 20)
3rt{*
eTtr|a-fi4ffi Mt em ffi Fri€Account Ooeninq Form for lndividual
Benericial Owner
t6crlt6t+t t||cl .l+qi:Beneficial Owner Account No:
e-ii g€fgd sqli ftzR"r iidf€.r qt cfu | qrqTirr (i-*R ilT\r*l
t€{"r ts-Aq.r+ al-drcr ffir+i a{iltf arcr rPlease complete
alldetails and strike outthe non-applicable {ields/boxes.
(h*q {r(g+f Erc / Name of Depository Participant).. (mqT
/Branch)
qt.ltat tatl+t: Ll c.{mrr.tTypes ofAccount: lndividualffit
k+tor
orqlqq qd-q-{d,r qrFr qr{For Offi.ial Us€ Only
qr+fi {q{ :Application No:
lstu :Date:
{+d nq{ :SymbolNo:
tr fu qr4r$qffi tr ffiNon Resident Nepalese Foreigner
fficrcName of &nefcial owner
Date of Birth
fE.i{.
A.D.
idqGender
!swMale
n cfrqrFemale
{rtrTdrNationality
Ll re,qlNepali
!raOther
Errrtafdr {q{Citizenship No: lssue District
qrt tuftlssue Date
(|F{|fi TqiPassport No:
qrft dFiPlace of lssue
qrft fqfdlssue Date tufr
Expiry Date
tdt{qTypes of
ldentitv Card
ldentificationNo.
lssuanceAuthority
qrft tutulssue Date
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correspondence Address:
{IE:Country :
Zore i District :
rfi.[4.{. /q qt. /q.q.ci.VDC/Municipality/lvetropolltan
dtilTole
qGIT q. : qiFq:Block No.:
Telephone No.:
rit{Fq i.:Mobile No.
IFIT:RI;t.:
Fax No.:
Ttsfi'
E-maii lD:
en4t &r+ :Permanent Address :
3tEirZone : District:
m.iq.g.tc.qt rc.q.ct.:VDC/N,Iunlcipallty/l','lelropolitan:
zfm
Tole
4gt q. :Ward No.:
aiiF {.rBlock No.:
TeleDhone No.: Mobile No.:
WIFRI;T.:
Fax No.: E-mail lD:
qftrfr+l ar-=.cr6:Nearest Landmark:
qd'rF{ qft-{|(fiI s?s{6-61 edfiqlDetails of Family Members
Gtand Father's Name:
cqrqir qrq :
Father's Name:
qrqFii {ft{ :
Motherls Name:
qfii/qfr{i qrq :Spouse's Name I
Eair{|si {rq :
Son's Name ;
3rffiFd dllr+l qrc :
unmaffied Daughter's Nane :
{drt+i qFI :
Daughter in Law's Name:
€gfifi ErrT :Father in Law's Name:
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q{rrrd ia{q :Details of Occupation :
im:Occupation:
n-4r { ! {.+rt I Rrdqt{+/Fl{t d-* f] q{.fi.m.,,qFi \r{ fi 3n. L
ErTfr kf, }Service Go!t. Public/Private Sector NGO/INGO Legar
Expert
tr tu{tqF D qrwt tr h{r{ n n-4r hTd tr .Ifr"ft ! {qExoert
Businesssoefon Student Retired Housewife Others
qrq|.+t giFRTypes of gusiness
-dtiFTtvlanufacturing
@ServiceOriented
!!
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qlq/ lr{ :Name/Surname;
fri{rdrni qqtr :Relationship with applicant :
qrrqn trrr+ :Correspondence Address I
{iE :Country :
srqq :Zone;
han :District I Telephone No. :
RIFRI i.Mobile No. :
eTfft tqr i.PAN No. :
€tq :
rt1Fd'ii f{-{qr ( Erd{-di i-{qT cr{)Guardian's Details (1. cese
of Minor only)
(qrarc+-+l arqr {rqr6 dqT iFrTirfi g+di st-cl {-ff{ rrt cfur(ln
case of minor, guardjan and m;nor's photos are required to
submit.)
v*er*-+i qrq :Guardian's Nam€:
6RTqT{ :
Signature:
fti-€d qrc :Applicant's Name I
6RTqI{ :
Signature :
qtST dq
srqi I srqiRight I teft
n-{ irrdrftq ffi ilFrtor ilon Resident Nepalese
*?ftr+ irrnr :ForeignAddress:
(na :City:
ITET
state
Country:+{3Trqrtgq +r-e c.NRN Code No. :
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qt6r dc
sfci I srqiRick I Left
*d sar61 q|FTBank Account Details
*o srard fufuq :Types of BankAc€ount:
E *+renr D qdl entSavingAccount CurrentAccount
q.& €tcl r1+q< / BanxAccounr Numoer:aqr*d *'* erer qr+i #
crc :t{ame ofBaok:
*+ qrsr$l {rcflame of Eranch :
giBlqii qfu €rE:!fr fc-
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qta aqThumb Print
Erqi I ErciRight I Left
Site Map of the Account Holder's Residence
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