ln l.e with lhe complEnce ,equnemenl ot Nepal R.stra Bank, Bankrng Oiiene and PurEhmeni Acl, .

.s well as olhlr Slatutory/

R69ulalory/ Bank's lnlehal Policy R.quiroment, l/We haGby declaro the following:

lM/. o. a member of My/ Our lam y is/a€ not a diector oI NIC ASIA Bank or do nol have any ruthodly to nomi.ate and
appoinl a Dteclor in NIC ASIA Bank.

2 A Di€clor ot NIC ASIA Bank orlamily member ol such Dr.dor iyare nol a mana96r. parln.r, agani or guaranto, nordo thoy
have any dned lnancial interesi in the respedive fim/comp3ny oMed by Me/Us

3 A Orcctor ol NIC ASIA Bank or member ol such Dnedols lamily rsJara not a shareholder holding moc than 10% share3 of
My/Our Frm/ company availinq loans lrom NIC ASIA Bank nor do they have any financial intercst rn lhc .ubFcl

a Dnedor of Nrc aslA aank or member ol such Dkecro.s family rs/are nol a guar.ntor to dedit facilities being avriLd by
fie./us liom NIC AS|Atunk.

5 UWe or My/Our lam ly is/are not a promoler, promoter sharehold€r or a sharoholder holdng more than 1% oltho totalassued
shares ol Nlc AsA aank or Shareholde. having ,rnancial ni€rest in the bank as per existing law or Managing agent or lsh.d
pany or CEo/sratuiory AudivLega Adviso/EmpLoyee ofN CASIA &.*.

UWe or My/Our tamily iyare .ol 3 lamiy momb€r o. clo66 ElaliveJ rffil {am fni.64t niF q-d tfr {q- q qn, qr! !'rlt,
ffi t
r, !Hi, ntrd arJ rrtr{ rtul m r+ !r{ r,rr, 6.r q&, m !F! ,R r+. {fi iHt {Ht Tr{1, itd{ !d tqq d) ol
Employee/CEo/Onado/Promolor at NIC ASIA Bank.

7 A shareholder of Nlc ASIA B.nk holda.g mo.e rhan 1% of the tota i6sued shares or an gmploy€€ ol th6 Bank is/are not a
shsreholder holdrng morE than 10olo chares oi lh.lim/cornpany o*ned by mo/us availing dedit lacililies frorn NIC tSlA &nk
nordo lhey have aoyvotrng nghl and linancialinteresl in lhs subl€d nm/@mpany.

8 The to3n berng avarled by me/us Ls nor berng e{ended aqahst collate.al assets omed by a promoter o. di.6clor or CEO ot
NIC l'slA Bank or a memb€r oflhetr iamily or agai.sl sha,es ol NIC ASla Ban*

9 Connrmaton on beow mennoned

a lam nota oredor/CEo o. nol at On'e. evei,[4anager al Level ol any Bank and Financrallnstitulons
b lam a Directo/CEo orat Officor laveuManagerial level of any Ba.k and Financlal instilulion and loan avail.d by ms in my
name ls only urde, Educalion loan, Hn6 Purcha$/Aulo loan Holsing loan a.d Consum./Oomestic Applianes loan
(!rE4 mi.ri {F. a)
c. I Em at Ollic€r leveuManagenal leveucEo ol lic€nsed Sank and Finanoal lnsdutions bul I do not hold more lhan 50% ol
sha/es n the F rm/Companyor lnsritution whrch 6 avaring orproposed ro avalcredt limits/facalitiEs lrofi NlCAS|ABank

10 l/w. anvare nol lEred in lh6 NIC ASIAs apprded vallator l$t

11. l/W5 ada.e nor convrcted by a courr olan o,iense involving morsl turpiiudo, cvl and criminal ofien@ 8nd senionc.d in
Gspect thereof. and a p€riod of le. years has not elapsBd iiom iho expiry of lhe sentencs or is nol an entiiy having major
fnancial inteEr ol such pe,son

12 l71/\/e orthB nm/onircompany's bank accounl rs.ol !.der liaeze slalus bywhalsoever roason

13. Audiror of my/oor Frn/Company b nor lhe shareholder holding 1% or more shaEs of NIC ASIA or a proprbtor/ PafieBhip
fim ot 6uch shareholder
 Section 5 Finan€ial Details

5r.teme.t of Frnan.ialPosition ol

aitete I liability Position

saling/Curr.nt A/C Fi.ed

AS|A Banl (Limit) oeposits at NIC AS|A Sant

b..k'finan.. companiet

Building:

Oths a55etr (pb. specily):

turniturc/Appli.net:

Tot.l A5icts:

I hereby.erirty thar lhe i.,ormatio. provided abole is irue and .ore(t. I am ready to provide i(wocabte guaranre td the to.n
bcitrq laken Irom you by the appli(antG) .. lrhallexecure the letter ol
slr.ntec i. Bank\ {ormot o .. ....... Loan ro rhir (rhse).ppli.ant (r)irapp'oved

signalurc ol 6u.ianlor
Name a.d Se.l ol the Guarantor
Dare:
 Section 6 - C.edit lnformation
Provide th. detaitt orcredir ia.iiitres wirh orhe. ban(r4inancralinrfturronr:

Nah. ol other Banki/ Ior.l Limitroutst.dd,n6

Flt trom lvhere credit Date..
r(sh.dd h.
rha^ t.n
nr lBrhsd ,."hftd)
cun- sc: ^orotds
Ott.r info.
t. ....... ... ...... E.nlqfi
. Workng capital Loan5

. Non tunoed rd.Ltris

2. ........ . .. .... ..Bdar(/Fl

. workns capiGlLo..s

. Non funded Fa<riries

t. ... ................,,., 3a.t/.i

T#Fh*::11;:j,:rx.r.r,,$.Tr ::::,:T:::H: fl .r:.,T j:-.[ ffi ::"1 ?,n o,-,

",
SectionT-Detailsof Guarantor (s) tro bec omplcted by individual
guaranto,s a5 appiopriate corpo.ate guarantors) firm,
Guaramee shoirtd be bbded by resolution ot Board o,

Relalion ol the Apptr..nV

Metlopoliran/Muni.ipatity/yDc
IoJe W.rd No.
riour€ No, Dinri<t

f.mily Tree ot appta<ant

Grandfathe/6randmother

r
2
l

l I
 -

tq ot,'io,t.l,,
4t cnari m qi{qr t{fufc-s,
nrqr{rqiqa, derddri,

{.Ii{,
prq +E$r frct{ E;i .rt !., ioi.) qn rci d1{Alc-{c, Erffi Yrq.rfi I 3FsrcrJiftri {ryi r]ii {+{66
q,,6rdrdri qr'r ?i+i (Sr qr dr .r-qrfqa *-;rqr (qr4rr rri ++ {cer itr rlr4i q,d r qqift (Et{rn gtfir
q{dqrFni 44{+fll1r{ Rnri aFrnrrerr qrrqitrl i ffiki q,;i r

{fFF, :nq, d. :qEr dflr{

irnar .ql.g fn,-aq_ar{,Fn k.q . { 'rr {el I ',

q5{fr<a 6<4r( fiadr 6{4rd

Fq;iE 6{EFr

rlnr 6r 'd{r a{r€-flri' .rfi +64r6iqrn * .ff"'t *f

{4
lD Y,'c;
?!xt