To be filled in by Bank’s staff Customer ID. )\\meca oe “Farts due eves KYC Details for Individual Account __| recen moors (aH ae 1) Full Name} fey Te feat aa Gender Male Female Others afew feats fair safeanter Marital Status Married. Unmarried 2.) ae ST 2.) Present Address: fae AAMT ST AT A sevnseede TST A, areas District: M.CN.DC..... .. Ward No. .... Street/Community ... wea ahaa aiaréa 4. House No. Telephone No. Mobile No. a Set THREE E-mail Address .. Website ) aunferar: amfcear 4 andl 4 fatear ard fat 3) Citizenship: Citizenship No. r Issuing District .. Issued Date .. OR (aq) ve) ee: en sn EL FET ard fat 4) Passport: Passport NO. wus... Issuing District ... Issued Date OR 4) fears (arararere afta erereat arreftet arf ara) 5) Identification (Introduced by Account holder, only for nepalese citizen) afcaaaaet fafa afvaaas 4. Type of Identification Certificate... ~ .. Identification Certificate NO. nee sare arf rere saret fat Issuing BOdY «...cnstsnnnnennennnnnene (SSUeM Date... nen 4) fae arretersy gar: rete caret 4 ar caret Fi ‘rer ora aren afer 6) Incase of foreign national: Passport No. Visa Expiry date ... 8, SU TETET HRT TTTATET ATH, Az, z, Bara € 2a a: 7. Name, Address and Telephone Number of the Landlord in case of living in a Rent: aR ata ATH, aT ‘Sart aferaia a Name, Surname of the Landlord Address Telephone Number Issuing Country ... Issued Date5) sfeare ace aaa 8 afeare aca emt 8) Family Details: Total number of Family Members afearcet weer wera fate arafeeet com frat eleord cifcanfew fare fame arte qaTsy AT | Family detail is not mandatory for foreign national, except provided voluntarily. wa aat am aT are a4 Farrar ardt fae. S.N. | Relation: Full Name Issuing District_| Issued Date 4 [ate aet Husband/wife arg, Father ara Mother art Grand Father att Grand Mother art ‘Son a mlurse|e «fu wf o art Daughter ARTE iow a Daughter in Law ARR tenes sere om Father in Law tao are Women wrlon|s ates eee ae ach sae eT OTe, Ore ai Arter face Saw AAT | Note: Please include the citizenship details of children above 16 years of age. ) aor eat fear: 9) Employment/Business Details: aera fart wen weet ag Meat seer meen fear Bar aga | Please Provide details seperately if you are involved in more than three entities) aa. Beara a oat 7 arpafad afte arent afeate SN. Name of Entity Address Position Estimated Annual Income/ Remuneration 4a 1 a 2 3 (jo) eat Ray ARE: cn 10) Permanent Account Number (PAN): (39) fren: 11) Education: .. ecseenneen (43) 33) ara Se ar fete dear are: w/w 12) | have Bank Account in other Bank or Financial Institution : (9) & Rerar arnt afoga aCe w/e 13) | have been convicted in any Criminal activities in the past: Yes / No Yes / Noae eee oT est fre rman fee Tare air ta Re TAT er MPC TTATAEERT ATLA TAT FeTSgRAD | Following documents have been enclosed as proof of identification while opening the account with this Bank (Please Tick Mark the documents enclosed). %) maerd fafacat mente aréaat Fret | a) Recent PP size photo. @) arafewat aa ceerttat ofafar | b) Attested copy of Citizenship Certificate or Passport. ag rrr ar weary arfercet ear fearon FA | ¢) Copy of employee ID card, if employed by any authority / entity. &) feet arfeway geet da ganna aferet teenie verter fates | d) Attested copy of Passport for Foreign National with valid visa. S) Teartt aaqar aredta amafewet gear ered qragarareat formic | e) Recommendation Letter of Indian Embassy for the Indian National not having Passport 3) Ane aeare at sey onfirerdte frmra feral afer raat ofatas creole grt) f) Copy of identification certificate issued by Nepal government (in the case of Refugee) 1B) ae zeta ofafan rare ewe ear afearenfermretarer are Tea 8) Copy of Birth Certificate Issued by local registrar (in case of Minor) a) fe ararfeer aurettet gwar Aare aeReeT aFafam freer are AUT Ae arenfem vicar afafea | h) NRN identification certificate issued by Nepal government (in case of Non-resident Nepalese) 1) Aa ACETATE ages ores faarem, wefaetee om farafaeterer ward, free at cearewet oitaaraet ofafas | i) Copy of employee ID Card, if employed in government grant affiliated School, High School and University as staff, teacher or lecturer, Professor. sy Saar afte ge oraa: At fatten fat ar wera GPa Wa aT ATT nfeaT wetfa aT Sera AeA EAT aie a | j) Photocopy of documents certifying address: water / electricity bill paid receipts / Voter's ID card / Land Ownership certificate / self declared location map in favor of individual living in a rent 8 ae deer are aie oT see ea feercoeear eH fads mee awEHT awa aT aT ATEN Frere sree pte ase eee ea sea warned gt O71 hereby agree to provide the changes along with supporting document if any, on above furnished details to the bank by me during the account opening process. The Bank shall not be hold liable/responsible for any consequence arises due to non-availing information to the Bank Ae ae arava Bg fe ertare wafers He sania At ATA afeR ew Tee | | hereby declare that all transaction to be made with my account will be as per prevailing laws. arf sete ater faacome sar dara srvarage gard to adt wa, wizeT set waa aatfas adaT awTeAT | All information and documents provided herein above are true and correct, if it is proved wrong, will face legal consequences. ci ee Signature of Account Holder fate Date: ate: freee ae aeRO Seay setae aT aft ary AAT |) Note: (Applicant has to present original document for the verification by Bank Staff.)Authority for Disclosure of the Bank account information: Please tick Yes ( \) or No (X) for each of the following questions: 1. Are you United State Resident? Yes No 2. Are you United State citizen? Yes No 3. Do you hold United State green card? YES No 4. Do you have a company/proprietership firm/partnership/private firm. YES No registered in United State? If either of the above answer is ‘Yes’, please fill the below details We, ... passport number .. place of issue place of Birth sn. having Social Security Number Residence of .. a Mega Bank Nepal Limited fo distlosa ray account ranscton or eam dor ee MERE regclctors or everseas tat authority where necessary. We understand that when disclosed, the said information or account transaction is used for overseas of domestic tax purpose only. Account holder Signature Account Number: Date: