4/10/2019 KYC - KSK

KYC (know your contributor)

Personal Information
First name * Middle name (Optional) Last name *

Urmila Bajracharya

PF Number * National Identity Card Number(NIC) Employee ID (Optional)

(Optional)
681455
नोट : कमचारी संचय कोष प रचय प न र Note: Your office ID number. (eg: PIS no., Computer
नोट - राि य प रचय प न र no., Employee no.)

Gender * Birth date (in B.S.) * Contribution Start Date (in B.S.) *

Male Year Month Day Year Month Day

Female
2018 Po 20 2064 Ba 1
Other

Nationality * Citizenship Number * Citizen Issued District *

Nepali 5019 KATHMANDU

Citizenship Issued Date(in B.S.) *

Year Month Day

2035 Je 6

Pan Number * Bank Name * Bank Account Number *

102178393 Prime Commercial Bank Ltd 00500500795cp

Contact Information
Mobile Number * Email * Country *

9841271415 urmilarajbajra@gmail.com Nepal

Note: Your own mobile number. Note: Your personal email

Permanent Address
State * District * Gaupalika / Nagarpalika *

Province No. 3 LALITPUR LALITPUR METROPOLITAN

Ward Number * Street *

02 Sanepa

Temporary Address
State * District * Gaupalika / Nagarpalika *

Choose State Choose District Choose Gaupalika / Nagarpalika

Copyright © 1994 - 2018 Karmachari Sanchaya Kosh. All rights reserved.

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4/10/2019 KYC - KSK

Ward Number * Street *

Other Infomation
Father Full Name * Mother Full Name * Grandfather Full Name * Spouse Full Name (Optional)

Padam bahadur rajkarnikar padam kumari rajkarnikar Krishna Bahadur Rajkarnika Kishor Raj Gubhaju (Bajrach
नोट: ीमान / ीमतीको नाम

Nominee Details (Optional)

Full Name Relationship Citizenship Number Citizenship Issued District

Kishor raj Gubhaju (bajracha HUSBAND 1048288 MAHOTTARI

Declaration
I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief and I undertake to
inform Karmachari Sanchaya Kosh (KSK) of any changes therein, immediately. In case any of the above information is found to be
false or untrue or misleading or misrepresenting, I am aware that I may be held liable for it.

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