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lmperiaL$ee Uriti_esCompany Pvt. Ltd.
qrr* - 1iAnnes - 13
(frFrqc io rirr ilryFqil){Pursant to Byelaw 20)
qT.ii.: IForm No.: 2
Emair:45'imperiar@gmair'com rE.tftffi arfm artfi erc dtrTrdt ffi qkn ffi Ffu
Format gf Account Openino Form for Gorporate Beneficial Owner
fiqtdq rfrffifir infir qraForOfficatUse Only
fit(:{ ilrfi :Application No.:
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$S'o q-q{ :Symbol No.:
a.rrffi ffi qrfl {rdr :Company's Beneficial Owner Account No.: 1
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arq-fr iqnq-{r frfrDate of lncorPoration
sEte fr.Pvt. Ltd.
qtdilo k.Public Ltd.
((Frt sltrfi qqdrGovt. Owned
ilffiNepal
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(FFIIFF ffit{d fr-{$rDetails of Clearing Member
rTtqT/Flqlqq (HT ( {s{ TH {nqr/6rcr{q'8re 1ilSlBranch/Number of offiee and Main !-try:1-:l9t1i:.t,"!t !
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s-dt rrt 6rcf{sRegistration Office
(di'i,Registration No
rdl'ftftRegistration Date
{qrft n€-r ?i.PAN No.
qq qWd qr( ir-dt {.VAT Registration No.
rfrrr+ crrrfr r{qrn qq6rrffi ffi{ t B"nqTNarne and Address of idain Companyin case of Subsidiary Company
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icrq'rrg +f,dr rdl'?i.NRB Registration No.
.tw w,ffir ttrry. ffillRB Approval Date+ I S' -?
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e'ft/qFffi qrs"Spouse's Name
qrgdt aqFathe/s Name
er&"qir iiqGrand Fathels Name
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effi{ 4.Telephone No
frqr{s i.Mobiie No.
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{qrffT,, Trdmrft sBe' { qTem' {qlEf$gqfr eE{pT (Details *f Directors, CEO and Authorised Account Operators}
t^^le shail accept to the terms and conditiis rglqtjry to tre asEeeqeq* getwgel.Pqpositorv participglF.gld Beneficial owner, prevailent act'
reourations, bveraws and any amendments on ii tA/t'e ["?l1i'i&-,i6i-Ltip-;{!fii'@;ffivl'oisctoddo details are true. I further herebv consent
r^i-^..^ anrr rinar anrinns in'mse anv false disctosuraoi inJ6iiidtioii rerat6o tb'rteius aniilti=Depository Participants reserve right to close my[31',ji,l31irilE5[""fl'.".1i';!#;i E!: iilqj,lffii eifirl;f,;ffitr EiiEtr 1ffi;1ufu.sr+,ttrii'Defositorv Participants reserve risht to crose mv
account. Ail disputes ure suUp.ito tlre jurisdiction ot CUU*s+n t
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