Application For

)x<
NICASIA

Please execute the payment innrucion as perfotowing detaik: Byway of RTGS/NEFT

Please entercurency and amountto be remiited
currency Amount (in fiqures) Amouni (n Words)

ordering customer (Specify the name and address of appticanvremiter):

Account with tnsrirurion (specifythe name, branch a.d address of beneft.iary s bank):

Befrli..ry c!nomer (spe.ly ihe nahe of.ddre* .l rhc re.e ver of funds Beneli. arj,rl

Charges on account ofi

Beneficiary (Re.eiver)

l^de hereby agree ihat th s rransf€r is made subj€ct ro

pr"u'"
f] a"rt,y ryc no. conditions prirted over eaf

T}trtr IrITtrT trtrtr txE irqndtu.6 (n ot eppt(d-i ... .. .....

slamp in case fi'rn/company
I e
"n'",".",n
cn,r,

! orn",pno,"
'p".
ry;,

tryCr n .nse of non .lnomer

d) Copy ol rirpl.anr'J idcnlif.at o. .crtft.are
bl aop es .l rEg strat on dnd PAN/VAT n .ase of fjfln/compnni-as
.) 5.urc-" ol lui. r, in .ase o1..sh depos r above NpF r,00(),OOO
FOR BANK 5 USE ONLY

Date:
Deta il of Transaction Currency
Remittance Amount

Total

Transaction wlll get execured on the vatue date mentioned above i.e.
 Terms And Conditions
1 Bv requestins anvtransre'rr"o,*" *,,..* rhar such rransre.shal be subj"..to tr.",J,u,.,.na.onarron,.
"i-
Th€ p€rforhan.eoirhk.ontact mcnt oned hare n by NtcAS|A Bank L mited (her€inafrer
rei*"; * il";;a"*1 i, *rp"
to a lrequlaiion, de.rees, adminisrrative rures orde6 and.ir.ura6 or Nepa Fanra Bankand
is ",r,"i.".p"*t *,r.-i -
i:.1_:l_!*"1*n:: :fi::1 :he eme and any ev€nrs beyond the coniror ol rh s bra n.h or tr" r,i r .;,0 ,s u,r ".r n
rmredtowrrpotitcatdist!rbance,ovd5ordeorexproprtation.tfloranyotrheaJoremenronedreasonsany.unomer
o/ .oume padv afie6 y toss or damage o ncurs any .on and expense, this trran.h
oi rhe bank in.tud nq princ pat
o-.d..d or c. b'd1, p...-b.d d, F5 old r a." o. .e b" i .1a[ -o. io-,e.pon. oe.o,,..ame.
2 hnr!.t onvRTGs oc€ e.&uied Gnnor be "nopped u.an.e[ed. charges b- a5 per Ba;k s s.r,"O,t" .i.r,,,g", * | 0" r"u
r rhetsanr&c€ptsrortrmsmEsononyandatthe<usromer,srisktoritemrnorpayabearrhisbran.h;llhesankThe "a
Bankw notberespo..ibteloraiytosordetayswhi.hmayb"-"."aOy,t,in"oioitu,..,,_O"yonU"-*.r-,r.,
anya.r, omission. nee e.r. defautr.la ureor insoven.yofany.o"".pona"nt.,,gent, o,.,u"q*L o,fl."i,
"ioiir,.*"
4' Shourdr€lu.d l.om or.epur.hase bvrhe Bank orrhe.mount ofrhe RTG'/NEFT or iun.rs rransrerred
ihroush any orh€r
mode byd€sned refund or repurchas€ shal be madesub]€.t lo su.h.ond
trons as may be p.*.0"a ru ti" g-t una u,
rh€ buyinq raie prevairins on rhar day ror rhe .u fton.y in q u-, _
the bafk s in posseson orrhe ru.ds ror whnh rha p;ymmt.,t.a."s -, " ppr"" or" -,.,, Ji.;;;; ;"",",, p.",
**" **a i"" ;,;;;y-";;""r" ""d
restr ct ohs ", ","".
5. The Sank may take ts clnomary ncps lor isslance ol RT6S/NEFT or tor remiitan.e a..ording ro rhis contra.i aid in so
doing, rhe Banks sha be free of behaff ofthe.rNonerro ma(e useol any corespoidents, ;ub aq€nr or otheragency
!.,,.:.".- ,.r8.-.o d.o o."o"".r"ri"o".i.-,,,." ,'"..;Fi;,.;..,,",
u, uerdys occurrrrq n ihewtrFo, cabteoron rhe parr otaiy.able ";.
orwnec$companyorauthorityoranyemptoyeeof
"..".
ouqh a,y other cau5e. The sank may send any mes;ee,"u,,u io,,un.r", rn *p .r
:,-1::Tr,1,',1, "flll:.,'",rh
6. Pease be advsed thar rn case ol iTGS/NEFI the romttance I be nq 5ent bythe Ban[ or is
aqeni ai vourent re nsk and
conandthartheBankorisaqenrcannotbehedt,abefo,a.y;nare,om6"of,det"yJt..*r,ir,."v"*"",n"
l" mnior reo,dioil-!, o .e .ne.p-,dt.oro n tS-o m,r d o
7 Anvra)6evedbvrhe,especnveqovenmenrofrh€.olntrywhe;elundsarebeingrehrted,suchraxessha
beborne
oyiieapp .ant/.us1omer
3 Theexchafg€app ed bythe Bank to .onveft ifto Forelgnvaile/Lo.alvatlethecustomets
tunds re.eived bythe Bank are
deemed to be a..eprabeto clnomel
o dq4.omr o qo6\..acrdorbe,FIb.(c..o...1
:a' - io F.,p.ar.d.
r0' TheBanr rese v€5 the rghrro spnd th s fund rransferJrom diflerenr pa.esorherrhan
the one5p€.iJied byrhe r€m.er in
.areof operatrona .tr.umsran(es sorcqured.
,, io any
ll::^,:T : e pavmenr roe..ha
l-iT::whe
o u'e counrrv '*l:" n ee conrror or orh er renrictions, wh ch may
be mposed by rhe rures and reeurations
be made Nettherrhe Bank nor rs.orrespondonts 0r aqenrs 5hal be rabtelo;any
ordelay caused byanysL.h rutes a.d €qLlations. tos
12. The B.nk w ll use e*onabe endoavor to process appicatiofs received by rhe
Bank durinq bankinq ho!6 and on rhe
sa me day. Appti.aijons rece ved arrer su.h cur orf
time wir be pro.e$ed on the nexr work,"q-a", i, ii.,iJ * b"
io turorr c-** -.,ii, -*a
".ii"it"""u * ""
p"1.""",.lv "
:lil1:e
oare oi requestand lms-ro .i,a.sm.no* ,nposed by rrrierna,.*r
rhe Banr wit not be trabte r. anylo$as a resutr ofdetay5 n transhission
or aaymcnl by rs setuants,
employees, corcspond€nrs orrh rd parties
ll allRTG5rem'ft.€si,esubr€.lioapp(abe.h g* perBankt(hedueorcharqesasrevis€dfromrmetonm€and
-a rr. dre! \ dpb ..d 6. . .e Bd . .,om rt . .eteldn
r4 rheBanrsob'gatoniunderrhesch€m@rhsao,eemenvarangem€nrwibes!bFc(roanyreasonoro.cutren.ebeyond
Baf r s .onr or iwherher roreseea 6 e o rot) ,ei,rrinq in prevei.""
r,.. - l; i;;;;;;;i;; ,, .",,r",,"".
+r.y _ i.r".i, pt
nctud ne. bltnor hired ro c vir comnor on, sa botuq", o.ro,t, ,t.
r" o, rur,oi .r ;"a i"il,r. ,td. *
ai",,t"
qled pt \o1. o. "9c:r."ooo-'tu
::::, -1"^jT:^'.i1't:r:li:: w" "i", o F,",iv- l.oon"ee'.,- "!, po.r",
o. -he .t""."r .,oo_o..q.":o,f,"r.r.-rs
rrre, ,ood. exposio., epidehic, qua,anrine resti.r on5, dama.
t. *" e."r.., -";;;;i":;,... .b,-*
ofthe""i"J",
ol Lsual means ol.ohmuni.atiof or rransporr or any orher.a;se, wh€ther
s;me or dtit**
-'_ *tr,",
-*" ,*^ u"l
p€rod thereaiterwth n wh.h any su.h obtiqarion in capabe otbe
_- rhe nq fuhled. "
ls herebv waives any afd al .amsh€mayhavcagainstrheBankwhicharisetrohorretarerolheiurdiransie.
'Lnom€r
requested bvthe cunomer, which s subiect ro rhese rerm !n e5s su.h
ca m arises lrom the r,",a o, *irii"r.,t atn.
l6 Erc_"plwh*etherawsolthe.oLnrrvof.onicr,rheRTG5remrttan.esharbesov€rnedbyrheawsolrhecountryotsu€.
r7 Banr w norbe abte ror afy d€ ay or os ns ns au" to tn.o.pr.ter*,onq nio.."r." ,lg",a.si...;"i;. b", *.",
a
lFScei.
13 Arr'e htrebyob qe bythe preva inq narltory r€qutarion loriNR ex.hange
19. l,arve hereby.onftm rhar, alihe suppodng documenrs subn(red fo;$is rransa.rion are genuine,
respons ble in case of any dupli.aie/iraudutenr documenrs ideniilied in luture
/we sha befuly

Authorised S qnature Stamp