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Transcript of aqrd Eftf qrgfr
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Annex-l-2
(fqfu{q ?" fr{ s'qfud)(Pursuant to Byelarv 2O)
cr€fu+. qfu-n't ffi rnrilr drd ftffit drqrFonnat of Account 0pening Fom lor lndiuidual Benefieial 0wner
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s["i. cForm No.: 1
o.rstoq 9-qts{6l 6rFI qra (ForOfficialUse Only)
eTffEq "I<[t Application No.:
fiil qrw Symbol No.:
frfr Date:
a-o irdfua Hqoi fus-{ur qrt'rtr r q-j t1{u I enqf,rr str5.n qq1rdl G-agq \3-dq .r{ otopq, ffi ffii qTPiGi5-drdr
Please complete all details and strike out the non-applicable fields/boxes.
fr&c E-{s-dI qrq : ilrrrd EfiI EftresName of Depository Participant: Nepal DP Limited (snqr / Branch):
srdrdr frfuq:Types ofAccount:
ffitG-s{sr
Ll qCIrralndividual
n fR eTrsr$q ffiNon Resident Nepalese
fernrffir ETfl qq{(Beneficial Owner Account No.)
E f{MForeigner
9 a o q q (t o o
ffitqrqName of Beneficial Owner
cr+I frfr (Dateof Birth) a..d. (8.s.) €.€. la.o.)
filq (eender) D gsq (Mate) E qeor (Female)
qT&q-dr (Nationatity) f,l ffi {Nepati) f] erq (other)
qtltfo6-fl qE{:Citizenship No:
cnff fu6rlssue District
qrt frftlssue Date
{r€l.Erft qq{ Passport No. qr$ ar€(Place of lssue qr$ frfr (tssue Date) I *nq lsfrri frfr(Expiry Date)
Cfq1lq-d Tr7pe5 ofu;I ftRTq ldentity Card
qfurqq* ldentification
=i.No.
qtt rr$ fto.rqlssuance Authority
Eilrt frfr lssue Date
tEffiIIt .f{ }qfqf, Correspondence Address:
YIE Country: SlsEf.Et Zone: fuerr, District:
m.ft.v./r.w1r..r.w.VDC/Municipality/Metrcpolitan
et6Tole:
trgl ;i.Ward No.:
qiE i.:Block No.:
tfrtEr){ =i.: (Telephone No.}: +fcrg,o ;f. (tzlobile No.):
Eqrffi t: FaxNo.: fto: {E-maiilD):
t?ff$ -&rn-qr: Permanent Address:
qqozone. fuor District: w'Ev./e.w.le.e.vr.VDC/Municipality/Metrcpolitan
dorole: qsr t Ward No.: e-O d": Block No.:
tfuw.t{ =i. : fielephone No.) : t'rer{d ;i. (Mobile No.)
S.qfffi t: Fax No.: S*o: {E-mailtD):;rfrro-dt er<sqrd Nea rest La nd ma rk:
tt
\JtFTq{ rTRqrrfir E-sgEs.EiI R-+qo1 p.1r;|s of Family Members
agr gerdl qrrT
Grand Father's Name:
5qr6l;Tl-cFather's Name:
OlrrlftFl ;ffq
Mother's Name:
qft, IrcffiI qrc
Spouse's Name:
ffiqrqSon's Name:
ofitffifp6 drfi-irl "rFIUnmarried Daughter's Name:
5erffir.nrDaughter-ln-Law's Name:
wgtr+1rr,r
Father-ln-Law's Name:
Eqrqa ft-q$rr
t{rOocrjpation
+sr tr sq-or$ tr srffiro/ffieE w.ddUqr€.s.S.dr. tl aEfift{Service Go/L PublidPrivate Sector NGO/NGO r egal Expert
trfuilErs tl qrclt tr GqFff tr fur tu{-d E gB,l E erqExpert Businessperson '' ShJdent Retired HouseWifu O*rers
qFIIrdI IT*TT
Types of Businxs
E vsr<cManuhcturing
tr +qrgdService Oriented
€terriri;rrTOrganization's Name
BIIl=TrAddress
qciDesignation
sTrPI$ ft-fiurFinancial Details
sTIdfCi frfl (SfiftF G-fl.I) /tncomeLimit(Annuat Detaits)
El E q,oo,ooo T[.rI E S. g,oo,ooq tfu S. ?,oo,ooo gupto Rs' 1,0o,0oo
From Rs. 1,oo,m1to Rs. 2,m,ooo
E 5,. ?,oo,ooq tfu s" !,oo.ooo gq f] s. tt,oo,ooo rril qIEFrom Rs. 2,OO,0O1to Rs. 5,0O,OO0 Abo/e Rs.
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freq lrffiS ffit srnrrT r+gdt qer6 sqrfuo sqqT | tr.Nrsi tr qrmgi
Standing lnstruction for the automatic transactions Evo Er,r"q,rtrrdl fr{$rr srE rr+A@untSbtemera.
trtF{o, tl srqrBo 3 wfro- Daily - Weekly - 15 dalrs
tr qrRroMonthly
Iidtrdr-dl B{tq 1am-ora-dt =.6'cr
q',) Guardian' Details (ln case of Minor
rTFT/eR Name/Sumame:
friqofuI iHF.rtI Retationship with appticant:
q?nqlY t II.TI conespondence Mdress:
IIIE Country: gf:Elo: bne
fuor:oistrict: efttdrr d. Telephone No.:
IDAIIiffi T. FaxNo.: dftrf{o {.: MobileNo.:
{QTrff +qr i. PANNo.:: t+6 E-rnailtD:
qle, q. rTr{rd{-+} E6,qr Tiqem deTr qri{r6iF EtdI ate} TiOr{ Tcq{E I
?" or{B €ra-o qg *1sqfu irrqsTrf, €trl-{ Tjcfu I
1. qrql irrqtg riqtro q\r!n E}tr qI drffiI sqfil sqruFqe-+1cfrifufi fu rp$61s. fr+{6idt Ewrsx defl eirsr urcqr €{Hq.6} EftrftHq.rslr fdrErrc ggcf;E r
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ic aTrqffrq ffiE I tl[FI ForNonResidentNepatese
&tr6 trrffi roreien Addres
Irft {city) q-q lstate)
Q31tuuntry lffiq drg =i. NRNCodeNo"
t{t qrtrd ff*gq (Bank Acount Deraits)
+6 iqmrd frfuc fiypesof BankAccount) E e-r;rd ElIflI SavingAccount flzrd grar CunentAccount
*o gnr ;Icft (Bank Account Number)
dcrfd *o grcr q$dr ffiI TIIT (NameofBank)
+fi YlrqIoll;ffi (Nameof Branch)
f6r{\to} qfu vq$ frqwr (Nominee'sDetaits):
Nt 5q q\rdl €ffien sr td Tsdd srrerrqr ffiI ErRF-S +t qrqqT qgdt q,Td .lffiI Eo-Erft .r{ qrstln the event of my death or incapacity, thefollowing named nominee shall be entifled to the balance of my demat account.
tI
6-6Erfi rr#r qrq:
NameofNominee:
ftffiIrlqrrgl:Relationship:
crrrrfu6ilr/wdcrfr TT{Citizenship/Passport No.
Gilt dr$Place of lssue
s+rAge
qarqK tqrn,Gonespondence Address:
tI$ (Country): SlEli6f (Zone);
fuot loistria;' tfrttDtc d. ftetephone No.):
q9ffi d 1raxruo.;: +cl5d i. llobitemo.;:
TQIrfi +qr i. 1eeruuo.;: {*o (r-mainD):
She Map of the Account Holde/s Residence
qr Ytdt Ter.q-frl rrffin
Location Map
From main road street ...........the distance of the Residence is ..........meten (approximately)
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l/\lle shalt acceptto the terms and conditions relating to the agreement between Depository Participants and Beneficial Ownef prevalent act, regulations, byelaws
and any amendments on it. l/We hereby acknowledge that the above disclosed details are true. I further hereby consentto bome any legal actions in case anyfulse
disclosure of information related to me/us and the Depository Participants reserve right to close my account. All disputes are subject'to the jurisdiction of courts in
Kathmandu, Nepal.
Fiqqrqi qrq :
Name of Applicant:
EffiT€N:
Slgnature:
SltdfgfC ThumbPrint
<rqi srdRight Left
6in,*'" qqt 6rdl qRrd c-drrr rd€rirrPlease use black ink
?712(ffi) Beneficial owner's copy
ffit qrelT;rRN:
Benefi cial Account Number:I a o q I \ o o
nf{N-qfofd fufl uf sha rehotder's Deta i ts
;IFI (Name)
effffiO ffiITeN Authorized signature
gfuffiI 1ft( (neceipt) qr+qq t (npflicationtrto.) ftfr ioate):
grfi-$ rErcn rell-d qrgrq gfufrtql I wereceivedaccountopeningtorm.
;ffi (Shareholder's Name)
fr&c vffidt qrrr: dur6 EfiI EfrB'Depository Participant! Name: Nepal DP Umited
Gi€EFI/Signature:
#fd qq/comparry's stamp:
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