NPR

g]=?=
Mr.
>Ldfg\

Mrs.
>LdtL

Ms.
;'>L

Minor
gfafns

Other
cGo

Others (Specify)
cGo -pNn]v ug]{_

A/C #
vftf g+=
Cust ID
vftfjfnfsf] kl/ro

Name :
gfd M
Marital Status:
j}jflxs l:ytL

Address:
7]ufgf
Tole

Married
ljjflxt

Unmarried
cljjflxt

Permanent Home
:yfoL 3/

Others (Specify)
cGo -pNn]v ug]{_

Temporary Home
c:yfoL 3/

Correspondence
kqfrf/

____________________

____________________ ___________________

____________________

____________________ ___________________

____________________

____________________ ___________________

gu/kflnsfuf=lj=;= ____________________

____________________ ___________________

6f]n

House No.

3/ g+=
P.Box.No.

kf]=aS; g+=
Municipality/VDC
Ward No.:

____________________

____________________ ___________________

District

____________________

____________________ ___________________

Zone

____________________

____________________ ___________________

Country

____________________

____________________ ___________________

____________________

____________________ ___________________

____________________

____________________ ___________________

____________________

____________________ ___________________

____________________

____________________ ___________________

j8f g+=
lhNnf

c~rn
b]z

Phone No.

kmf]g g+=
Mobile No.

df]afOn g+=
Fax No.

ofS; g+=
E-mail

Od]n

Religion:

Hindu
lxGb"

wd{

Buddhist
af}4

Educational Qualification:

Literate
;fIf/

z}lIfs of]Uotf

Occupation:

Islam
O:nfd

Christian
O;fO{
SLC
P;=Pn=;L=

Salaried-Govt./PSU/Others
hflu/];/sf/L;fj{hlgs ;+VofcGo

Joj;fo

Total Annual Income

hDdf jflif{s cfo -JolQmsf] xsdf_

Graduate
:gfts

Post Graduate
:gfQf]sf]Q/

Retired-Govt./PSU/Others
;]jf lgj[t;/sf/L;fj{hlgs ;+:yfcGo

upto 50,000
%),))) ;Dd

(for individual)

Others (Specify) _______________________________

cGo -pNn]v ug]{_

upto 1,00,000
!,)),))) ;Dd

Other ____________________
cGo

Student
ljBfyL{

upto 1,50,000
!,%),))) ;Dd

Housewife
u[lx0fL

upto 5,00,000
%,)),))) ;Dd

Other_______
cGo

more than 5,00,000

%,)),))) eGbf dfly

(If Self Employed, tick appropriate box):

-olb :j/f]huf/ xf] eg] pko'Qm sf]i7df lrGx nufpg'xf];\_

Medical
:jf:Yo

Engineers
cleoGtf

Professor
k|fWofks

Trading
Jofkf/

Nature of Business:

Jofkf/sf] lsl;d

Total Annual Turnover

CA/ACCA
rf6{8{ PsfpG6]G6Pl;l;P

(for Corporate Business House)

hDdf jflif{s sf/f]af/ -Jofkfl/s ;+:yfsf] xsdf_

Whether Income Tax Assessee:

cfos/ bftf xf] jf xf]Og <

Constitution:

Sole Prop.
Psn :jfldTj

u7g

Service
;]jf

Industry
pBf]u

Yes
xf]

Credit
qm]l86

Other______________________
cGo

Upto 1 crore
! s/f]8 ;Dd

Upto 10 crore
!) s/f]8 ;Dd

more than 10 crore

!) s/f]8 eGbf dfly

No
xf]Og

Partnership
;fem]bf/

Debit
8]lj6

5 eg], sf8{sf] k|sf/ M

Agriculture
s[lif

Others, Specify:_______________________________________
cGo, pNn]v ug]{

Upto 25 lakhs
@% nfv ;Dd

P.Ltd.
k|f=ln=

Are you availing Debit/Credit Card facility ?

s] tkfO{n] 8]lj6qm]l86 sf8{ ;'ljwf k|of]u ug'{ ePsf] 5 <
If yes, Types of card :

Business
Jofkf/

Visa
le;f

Ltd.
lnld6]8
Yes
5

Master
df:6/

Corporation
;+:yfg

Other_____________________
cGo

No
5}g
Other (Specify)__________
cGo -pNn]v ug]{_

If Account a Non Resident Nepalese (NRN) or Foreign National

s] vftf u}/ cfjf;Lo g]kfnL jf ljb]zL /fli6osf] xf]

Yes
xf]

Expiry date:___________
e'Qmfg ldlt

No
xf]Og

None
s'g} klg xf]Og

If yes, Foreign Citizen : Country: _________________ VISA No.:_________________ Date of Issue_______________ Validity:______________

xf] eg], ljb]zL gful/s

S.No.

Relation

qm=;+=

gftf

Spouse

Father

Mother

Grandfather

@
#

$
5

6.1

ktLkTgL
afa'

cfdf
afh]

Grandmother

aHo}

Son 1

^=!

5f]/f !

6.2

Son 2

^=@

/fi6

5f]/f @

le;f g+=

hf/L ldlt

;dofjlw

Full Name

Citizenship No.

Place of Issue

Issued On

Tel/Mob.No.

k"/f gfd

gful/stf g+=

hf/L u/]sf] 7fpF

hf/L ePsf] ldlt

kmf]gdf]= g+=

_______________________

_____________

_________

___________ __________

_______________________

_____________

_________

___________ __________

_______________________

_____________

_________

___________ __________

_______________________

_____________

_________

___________ __________

_______________________

_____________

_________

___________ __________

_______________________

_____________

_________

___________ __________

_______________________

_____________

_________

___________ __________

6.3

Son 3

_______________________

_____________

_________

___________ __________

_______________________

_____________

_________

___________ __________

_______________________

_____________

_________

___________ __________

_______________________

_____________

_________

___________ __________

_______________________

_____________

_________

___________ __________

_______________________

_____________

_________

___________ __________

_______________________

_____________

_________

___________ __________

_______________________

_____________

_________

___________ __________

_______________________ _____________
*=%
;+/Ifs -gfjfnssf] xsdf_
* Wife of Son -5f]/fsf] kTgL_, ** In case of Married Women -ljjflxt dlxnfsf] xsdf_

_________

___________ __________

^=#

5f]/f #

7.1

Daughter 1

&=!

5f]/L !

7.2

Daughter 2

&=@

5f]/L @

7.3

Daughter 3

&=#

5f]/L #

8.1

Daughter-in-law 1*

8.2

Daughter-in-law 2*

8.3

Daughter-in-law 3*

8.4

Father-in-law**

8.5

Guardian (incase of minor)

*=!

*=@
*=#

*=$

a'xf/L
a'xf/L
a'xf/L
;;'/f

Detail of Local Contact Person in Nepal

g]kfndf :yfgLo ;Dks{ JolQmsf] ljj/0f

Name: ______________________________________________________________________________________

gfdM
Address: Zone____________________ District ______________ Municipality/VDC___________Ward No. ______

7]ufgf

c~rn

lhNnf

gu/kflnsfuf=lj=;=

j8f g+=

Phone No.: __________ Mobile _______________ Fax No.: __________ E-mail:____________________________

kmf]g g+=

df]afOn g+=

ofS; g+=

Od]n

Relationship to me : ____________________________________________________________________________

d ;+usf] gftf
Whether dealing with any other bank or already have an account with this bank, if yes, please give details:

olb cGo s'g} a}+s;+u sf/f]jf/ eP jf o; a}+s ;+u klxNo} vftf ePdf ljj/0f lbg'xf];\ .
Name of the Bank & Branch
a}+ssf] gfd / zfvf

Facilities/services being availed / k|fKt u/]sf ;]jf tyf ;'lawfx?

SA/art bftf CA/rNtL bftf

OD/cf]e/ 8f6

LOCATION MAP OF CLIENT'S RESIDENCE (To be filled by customer)*/u|fxssf]

N

TL/6d{nf]g

Others/cGo

3/ 7fpFsf] gS;f -u|fxsn] eg'{kg]]{_

Tick( )the appropriate boxes and fill the required details:

;xL sf]7fdf ( ) l7s lrGx nufpg'xf]; / cfjZos ljj/0f eg'{xf];
In Case of Permanent Address:

:yfoL 7]ufgfsf] xsdfM

House-Land Ownership Certificate &/or
3/ tyf hUuf wgL k|df0fk'hf{ /cyjf
Bill of Water/Electricity &/or
ljh'nLkfgLsf] lan /cyjf
Voting Identity Card &/or
dtbftf kl/rokq /cyjf
Report of site visit of customer's residence done by NIB staff with location map &/or
o; a}+ssf sd{rf/Lf/f u|fxssf] lgjf;sf] :ynut lg/LIf0f u/]sf] k|ltj]bg /cyjf
Any other document/s _________________________________________________________________________
cGo sfuhftx?
In Case of Temporary Address:

c:yfoL 7]ufgfsf] xsdfM

Certified photocopy of House-Land Ownership Certificate of current residence &/or
xfnsf] 3/hUufsf] nfnk'hf{sf] k|dfl0ft 5ljlrq
Bill of Water/Electricity of current residence
xfn 3/sf] ljh'nLkfgLsf] lan
In Case of Residing in a rented house:

ef8fsf] 3/df a;f]af; ug]{sf] xsdfM

Full Name of Landlord : ________________________________________________________________________
3/wgLsf] k"/f gfd
Full Address : ________________________________________________________________________________
k"/f 7]ufgf
Tel.No. : ____________________________________________________________________________________
6]lnkmf]g g+=
Other additional details (if any) : __________________________________________________________________
cGo yk ljj/0f -ePdf_
In Case of Indian Citizen:

ef/tLo gful/ssf] xsdfM

Certified Recommendation/Registration letter from Indian Embassy - Nepal
ef/tLo /fhb'tfj;g]kfnaf6 k|dfl0ft sfuhftx?
In Case of Refugee:

z/0ffyL{sf] xsdf M
Identification issued by Home Ministry, Government of Nepal, or ________________________________________
g]kfn ;/sf/, u[x dGqfnof/ hf/L kl/rokq, cyjf
Personal Identification of Refugee
z/0ffyL{sf] JolQmut kl/rokq