Branch Name : NAGESWARI Account No : 5212601000716

Applicant's Name : SOBUJ CHANDRA MALAKAR

Father's Name : Mr. Bideshi Malakar
Mother's Name : Mrs. Sunti Durga
Spouse Name(If applicable) : Sobuj malakar
Date of Birth : 1999-01-06
Gender(M/F/T) : male
Profession : Garments Worker
Mobile Number : 01310902251
Present Address : Vill/Road: Nageswari, Post: Nageswari, Upozila:
NAGESHWARI, Dist: KURIGRAM

Permanent Address : Home / Holding: Green Villa, Village / Road: Kamar Para,
Ward No-05, Post Office: Nageshwari-560, Nageshwari,
Kurigram

Nominee Name : Kozoly rani relation : Wife

Specimen signature/digital signature(where neccessary) : .......................

1. Has UNSCRs Check done ? (yes) (no)

3. Has review of customer profile done (existing customer)? if so, date of review ....
3. What is the average range of customer transcation (over 6/12 months)?.....
4. Any other relevant field may be add here.............