C-ASBA Registration Form

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d]/f]÷xfd|f] lgDg adf]lhd lxtu|fxL vftfdf hDdf ug{sf nflu To; a}+sdf cfjZos Joj:yf ul/lbg' x'g / C-ASBA
Registration no. (CRN) pknAw u/fO{ lbg' x'g cg'/f]w ub{ 5'÷5f}+ .
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lgIf]k ;b:o gDa/ (DPID): lxtu|fxL gDa/ (Client ID):

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k'/f gfd Mr./Mrs./
In English Use Capital Letter
Miss/Minor
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Perma nent Ward House
Province District Municipality Street
Address No. No.
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Ward House
Current Address Province District Municipality Street
No. No.

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cfj]bgsf] b:tvt
(Applicant's Signature)
(Page 1 of 2)

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(Customer's Copy)
tkfO{ >L ===================================================== sf] lgj]bg cg';f/ lwtf]kq vl/bsfnflu cfjZos kg]{ C-ASBA Registration g+= (CRN)
=============================== k|bfg ul/Psf] 5 . s[kof lwtf]kq vl/b -;fj{hlgs lgisfzg_ sf] cfj]bg cgnfO{g dfkm{t jf a}+ssf] s'g} klg
zfvfdf b/vf:t lbFbf ;f] CRN g+= cfjZos kg]{ x'gfn] ;'/ lIft /fVg' x'g cg'/ f]w ub{5f}+ .

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Bank Stamp:
 cfj]bssf] afa'sf] gfd
Father's Name Use Capital Letter

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cfj]bssf] afh]sf] gfd
Use Capital Letter
Gra ndfather's Na me
cfj]bssf] klt÷klTgsf] gfd
Use Capital Letter
Spouse's Na me
;+/Ifssf] gfd
-gfafnssf] xsdf_
Gua rdian's Na me Use Capital Letter
(Incase of Minor)

k'g Zr M dfly pNn]lvt ljj/0f k|of]u u/L, To; a}+sn] k|bfg u/]sf] /lhi6«]zg gDa/ (CRN Number) pNn]v u/L lwtf]kq
vl/b cfj]bg lbFbf l;l8P;l;n] k|bfg u/]sf] OG6/g]6df cfwfl/t ;]jf æd]/f] z]o/Æ dfkm{t \ jf To; a}+ssf] zfvfx?df pknAw
ef}lts cfj]bg kmf/fd e/]/ a'emfP afkt d]/f]÷xfd|f] vftfdf df}Hbft /x]sf] /sd /f]Ssf /fVg tyf afF8kmfF8 kZrft\ k|fKt x'g]
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:yfgfGt/0f (Transfer) u/fpg ;fy}, To; a}+sn] ;fj{hlgs ?kdf pNn]v u/]sf] lwtf]kq vl/b lgj]bg z'Ns ;d]t ;f]xL
vftfaf6 s§f u/L c;'n pk/ ug{ d]/f]÷xfd|f] dGh'/L /x]sf] 5 .

============================
cfj]bgsf] b:tvt
(Applicant's Signature)

a}+s k|o f]hgsf]nfluM

b/vf:t a'lemlng] / k|dfl0ft ug]{ clwsf/Lsf] gfdM
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(Page 2 of 2)

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