Know Your Contributor (KYC)

Submission Number To be filled at KSK

UCIN (KYC no)

15812369758248894
Personal Information
Name MOHAN PRASAD GYAWALI
Pf Number 8248894
National ID 9846
Employee ID 770961
Gender M
Date of Birth (in B.S.) 2035-9-15
Contribution Start Date (in B.S.) 2076-4-1
Nationality Nepali
Citizenship Number 9846
Citizenship Issued District Rupandehi
Citizenship Issued Date (in B.S.) 2054-10-23
PAN Number 107528144
Bank Name Nic Asia Bank Ltd
Account Number 287963339452401
Contact Information
Mobile 9860669503
Email daonnefeeds1992@gmail.com
Country npl
Permanent Address Province No. 5, Rupandehi, Siddharthanagar Municipality-2,
Bhairahawa
Temporary Address Province No. 5, Rupandehi, Siddharthanagar Municipality-2,
Bhairahawa
Other Information
Father Name TOY NARAYAN GYAWALI
Mother Name TIKAMAYA GYAWALI
Grand Father Name PURNABHADRA GYAWALI
Spouse Name MUNA REGMI
Nominee Details
Full Name MUNA REGMI
Relationship WIFE
Citizenship Number 373006/134
Citizenship Issued District Rupandehi

Declaration
I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief and I
undertake to inform Karmachari Sanchaya Kosh (KSK) of any changes therein, immediately. In case any of the above
information is found to be false or untrue or misleading or misrepresenting, I am aware that I may be held liable for it.

............................................................
Contributor's Signature
Required documents to be attached:
1. Photocopy of Citizenship Card or Passport.
2. Photocopy of Employees Provident Fund Card.

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