Buddha Power & Technology Pvt.

Ltd

Tilottama-05

Staff - KYE FORM

KYE NO: DATE:

Full Name:
PHOTO
Date of Birth:

Permanent Address:

District Municipality / V.D.C Ward No. Tole / Street / Road

Land Line Mobile Email Address:

Current Address

District Municipality / V.D.C Ward No. Tole / Street / Road

Land Line Mobile Email Address:

Citizenship No. Issued by Issued Date

PAN No.

Family Details
S.No Relation Name Citizenship Issue Date Issue District
No

1. Spouse

Husband/Wife

2. Father

3. Mother

4. Grand Father
5 Grand Mother

6. Son/Daughter

1.

2.

3.

4.

7. Daughter In
Law

8. Father In Law

Profession of Spouse Education Contact No.

Do you Have Account in Any Bank? YES NO

If Yes Name of Bank /Address/Account No.

1. Name: Address: Account No:

2. Name: Address: Account No:

3. Name: Address: Account No:

4. Name: Address: Account No:

5. Name: Address: Account No:

Are you availing Credit Facilities with any Bank? YES NO

If Yes Name of Bank & Address

 1. Name: Address: Account No:

2. Name : Address: Account No:

3. Name: Address: Account No:

4. Name: Address: Account No:

5. Name: Address: Account No:

Self Declaration
Declaration of Convicted/Non Convicted for Any Crime in Past YES NO

If Yes Please Specify

Do You Hold Residence Permit of Foreign Country YES NO

If Yes Please Specify Country*

Person staying of rent Details

House Owner’s Name: Phone No: Mobile No: Present Address

Location Map of Permanent Residence

Location if Other then Permanent Residence

Name of References: Address: Mobile No:

THUMB PRINT

Right Left

…………………………………………………
Signature

I hereby declare that all the information contained in this form herewith is true in all respect. If found
otherwise, I will be fully responsible as per the prevailing law.

………………………………………… ………………………………………… ……………………………..

(Prepared By) (Checked By) (Approved By)

Name: Name: Name:
Designation Designation Designation