u|fxs klxrfg kmf/d-;+:yfut vftf - KYC Form-Corporate)
zfvf /Branch: ______________ vftf g+=÷Account No.____________________ ldlt÷Date: D D M M Y Y Y Y
;+:yfsf] lsl;d Psn kmd{ ;fem]bf/L kmd{ k|fO{e]6 lnld6]8 klAns lnld6]8
Nature of Entity Proprietorship Partnership Firm Private Limited Public Limited
cGo -s[kof pNn]v ug{'xf]nf_ : ...............................................
Others (Please Specify)
;+:yfsf] ljj/0fx? -Institution Details_
;+:yfsf] k'/f gfdM …………………………………………………………………..................………...........................… -b]jgfu/Ldf_
Full Name of the Entity) (In Block Letters)
;+:yf÷sDkgL btf{ k|df0fkq btf{ g+======================================================== btf{ ldltM =================================================
Registration Nu mber Date of Establish ment
btf{ ePsf] sfof{noM=========================================================================== Eof6÷:yfoL n]vf gDa/ =================================
(Reg istered With) VAT/PA N Nu mber
Aofh s/ 5'6 kfpg] -Interest Tax Exempted) : xf] xf]O{g -xf] eg] ;DalGwt sfuhft k]z ug'{xf]nf_
Yes No (If Yes enclose supporting evidence)
btf{ x'bfFsf] 7]ufgf - Registered Address_ M
kf]=a=g+========================= /fi6«…...................….… c~rn:…............….……. zx/========================lhNnf===========================
(P.O.Bo x No.) - Country _ -Zone_ - City_ - District_
uf=lj=;=÷gu/kflnsf…...................................... j8f g+=:…........… uNnL÷6f]n……......................……… 3/ g+=: …......……………
(VDC/Municipality) (Ward No.) (St reet/Tole) (House No.)
;Dks{ g+= …..........................km\ofS; g+======================== . O{d]n 7]ufgf=================================. j]a;fO6============================== .
(Contact No.) (Fax No.) (Email Address) (Website)
/lhi68{ 7]ufgf - Registered Address_ -olb btf{ x'bfFs f] 7]ufgf kl/jt{g ePsf] eP kl/jt{g ePsf] 7]u fgf÷ If the registered address has
changed after the initial registration)
c~rn:…............……. zx/=======================lhNnf=====================uf=lj=;=÷gu/kflnsf …..................................j8f g+=:…...........
-Zone_ - City_ - District_ (VDC/Municipality) (Ward No.)
uNnL÷6f]n…….......................……… 3/ g+=: …......……...………;Dks{ g+=….............................km\ofS; g+===========================.
(Street/Tole) (House No.) (Contact No.) (Fax No.)
;Dks{÷:yflgo 7]ufgf (Communication/Local Address ) - olb /lhi68{ 7]ufgf eGbf km/s ePdf÷ If different from Registered
Address)
7]ufgfM================================================================================================================================================================
kf]=a=g+========================= /fi6«…...................….… c~rn:…............….……. zx/========================lhNnf===========================
(P.O.Bo x No.) - Country _ -Zone_ - City_ - District_
uf=lj=;=÷gu/kflnsf…...................................... j8f g+=:…........… uNnL÷6f]n……......................……… 3/ g+=: …......……………
(VDC/Municipality) (Ward No.) (St reet/Tole) (House No.)
;Dks{ g+=-!_…................................................;Dks{ g+=-@_ …...........................................km\ofS; g+=========================================== .
(Contact No.1) (Contact No.2) (Fax No.)
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zfvf÷sfof{no ;+Vof (No. of Branch Office of the Firm/ Co mpany) M===============================================================================
d'Vo zfvf÷sfof{nox? /x]sf] :yfg (Location of Branch Offices) M !========================================@=====================================
#========================================$=============================================%=======================================^=====================================
Joj;fosf] k|s[ltM pTkfbg Jofkf/ ;]jf cfoft÷lgof{t ko{6g u}/ ;/sf/L ;+:yf
(Nature of B usiness) Manufacturing Trading Service Import/ Export Tourism NGO/ NPO/INGO
cGo -s[kof pNn]v ug'{xf]nf_ : ………...................................……………....................................................................................………….…
Others (Please Specify)
kl5Nnf] cfly{s aif{sf] sf/f]af/ /sd (Annual Turnover -last fiscal year i n NPR): ……........................................................................
rfn' cfly{s aif{sf] cg'dflgt sf/f]af/ /sd (Expected Annual Turnover-current fiscal year) (in NPR):.........................................
vftfdf x'g] aflif{s cg'dflgt sf/f]af/ /sd -s[kof -√ _ lrGx ;DalGwt sf]7fdf nufpg'xf]nf_
Expected transaction volume in the account per annum (Please tick (√) in appropriate box)
?=!) nfv;Dd (Up to NPR 1 Million) ?=%) nfv;Dd (Up to NPR 5 M illion) ?=! s/f]8;Dd (Up to NPR 10 Million)
?=$) s/f]8 ;Dd (Up to NPR 400 M illion) ?=$) s/f]8eGbf dfly (Above NPR 400 M illion)
vftfdf x'g] aflif{s cg'dflgt sf/f]af/ ;+Vof -s[kof -√ _ lrGx ;DalGwt sf]7fdf nufpg'xf]nf_
Expected No. of transactions in the account per annum (Pleas e tick (√) in appropri ate box)
@) j6f eGbf sd -Below 20 transactions_ %) j6f ;Dd -Up to 50 transactions_ !)) j6f ;Dd -Up to 100 Tansactions_
!)) j6f eGbf al9 -Above 100 Transaction_
ut cfly{s aif{sf] n]vfkl/If0f k|ltj]b g k]z ul/Psf] 5 . 5 5}g
Audi ted Fi nancials of the last fiscal year submitted Yes No
sfo{sf/Lx?÷;+rfnsx?÷k|f]k|fO{6/÷;fem]bf/x?÷sfo{ ;ldlt ;b:o -sf]if÷;ldlt_
(Details of Chief Executi ves/ Directors/ Proprietor/ Partners/ Member of B oard (Trust/ Committee)
qm=;+= gfd -Name) kb-Designation) 7]ufgf -Address) ;Dks{ g+=-Contact No.)
S.N.
!
@
#
$
%
^
lxtflwsf/L -k|ToIf ?kdf !)% jf ;f] eGbf al9 z]o/ wf/0f ug{] z]o/wgL_ x?sf] ljj/0f
-Details of Direct Beneficial Owners (Owners hol ding 10% or more shares directly)
qm=;+= gfd -Name) 7]ufgf -Address) ;Dks{ g+= sfod /x]sf] z]o/ k|ltzt\
S.N. -Contact No.) -Percentage of Share hol di ng)
!
@
#
$
%
^
vftfjfn sDkgLdf !) % jf ;f] eGbf a9L z]o/ wf/0f ug{] k|To]s sDkgLsf] nfuL 5'§f 5'§} ;+:yfut u|fxs klxrfg kmf/fd
eg'{xf]nf (Please fill the seperate KYC form-for Corporate for each shareholding company holding 10% or more shares)
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cGo ;DalGwt ;+: yfx?sf] ljj/0f -Details of Siter Concern) (If any)
qm=;+= ;DalGwt ;+:yfsf] gfd Joj;fosf] k|s[lt 7]ufgf -Address) ;Dks{ g+= vftf g+=-A/ C No.)
S.N. -Name of Sister Concern) -Nature of Business) -Contact No.) -If maintained wi th the
Bank)
!
@
#
$
%
^
cGo a}+s;+u ;DalGwt ljj/0f (Other Bank Details)
s] tkfO{sf] cGo a}+sdf vftf 5 < 5 5}g
(Do you have Account with another Bank?) Yes No
olb 5 eg], a}+ssf] gfd -!_ …….…..……………………………………. vftf g+= …….…..……………………………..…
(If yes, Name of the Bank (1) (Account No.)
a}+ssf] gfd -@_ …….…..……………………………………. vftf g+= …….…..……………………………. .…
Name of the Bank (2) (Account No.)
:j3f]lift gS;f (Locati on Map):
glhssf] d"n;8s af6 3/÷8]/f;Dd k'Ug] af6f]sf] gS;f (Location Map of the Residence fro m the Main Road)
pQ/ (North)
glhssf] d"n;8s==============================================================af6 3/÷8]/f ;Ddsf] b'/L ===================ld6/
Fro m Main Road ================================================================the distance of the Residence is ===================meters.
s[kof ;+nUg sfuhftx?sf af/]df lrGx nufpg'xf]n f - Please tick mark the documents enclosed)
?h' ug{s f] nflu ;Ssn sfuhft k]z ug'{xf]n f -Originals to be submitted for verification)
;a} k|s f/sf ;+:yfut vftfx?sf] nfuL -cfjZoStf cg';f/_ (For all types of accounts (as applicable)
kmd{÷ sDkgL btf{ k|d f0fkqsf] k|dfl0ft k|ltlnlk -Attested Company /Firm Registration Certificate)
Kofg÷Eof6 btf{ k|d f0fkqsf] k|dfl0ft k|ltlnlk -Attested PAN/VAT Registration Certificate)
s/r'Qmf k|df0fkq -Up to date Tax Paid Receipt)
vftf ;+rfns, k|f]k|f O{6/, ;fem]bf/, ;+rfns, tyf lxtflwsf/Lsf] kf;kf]6{ ;fO{hsf] kmf]6f] -Passport size photos of Account Operators,
Proprietor, Partners, Company Directors & Individual Beneficial Owners)
vftf ;+rfns, k|f]k|fO{6/, ;fem]bf/, ;+rfns, tyf lxtflwsf/Lsf] gful/stfsf] k|dfl0ft k|ltlnlk (Attested Citizenship Certificate copy
of Account Operators, Proprietor, Partners, Company Directors & Individual Beneficial Owners)
vftf vf]N g / ;+rfng ug{sf] nfuL ;+rfns ;ldltsf] lg0f{o - Board Resolution to Open and Operate account )
cl3Nnf] cf=a=sf] n]vfkl/If0f k|ltj]bg -Previous F/Y Audited Financials)
vftf ;+rfns, k|f]k|f O{6/, ;fem]bf/, ;+rfns, tyf lxtflwsf/Lsf] u|f xs klxrfg k mf/d -KYC forms of Account Operators, Proprietor,
Partners, Directors & Beneficial Owners)
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j}b]lzs d'b|fsf vftfx?sf] nfuL -cfjZoStf cg'; f/_For Foreign Currency Account (as applicable)
g]kfn /fi6« a}+ssf] l:js[tL -NRB Permit)
ljb]zL d'b|f cfDbfgLsf] sfuhft -Foreign Currency Income Supporting Documents)
;fem]bf/L kmd{sf] vftfsf] nfuL - For Partnership Firm Account )
;fem]bf/L ;DalGw ;Demf}tfsf] k|dfl0ft k|ltlnlk -Attested copy Partnership Deed)
sDkgLsf] vftfsf] nfuL - For Company Account)
k|jGwkq tyf lgodfjnLsf] k|d fl0ft k|ltlnlk - Attested copy of AOA/MOA)
z]o/wgLx?sf] ljj/0f -k|j Gw kq lgodfjnL eGbf km/s ePdf_ - Latest Shareholding pattern (Incase of changes)
;+3 ÷;+:yfx?sf] vftfsf] nfuL - Society/Clubs/Associations)
ljwfgsf] k|d fl0ft k|ltlnlk -Attested copy of constitution /By Laws/Statutes governing the organization)
;dfh sNof0f kl/ifbsf] cfj4tf k|d f0fkqsf] k|dfl0ft k|ltlnlk Attested affiliation Certificate with Social Welfare Council
(SWC)
We hereby declare that the information provided herein above and documents furnished are complete, true and correct.
xfldn] oxf+ k]z u/]sf sfuhftx? tyf pknAw u/fPsf] hfgsf/L k'0f{, ;fFrf] / ;To 5g\ .
plNnlvt ljj/0fx?df s'g} kl/jt{ g ePdf ;f]sf] hfgsf/L #) -lt;_ lbg leq a}+snfO{ pknAw u/fpg dGh'/ ub{5f}+ / pQm ljj/0fx?
cBfjlws gu/fPsf] sf/0fn] x'g] s'g} lsl;dsf] xflg gf]S;fgL k|lt a}s
+ hjfkmb]xL x'g]5}g . (We hereby agree to notify the bank and
furnish documents thereto within 30 days in case of any changes in the above details and the bank shall not be held liable fo r any
consequences arising out of the same.
sDkgLsf] 5fk (Organization Seal) cflwsfl/s x:tfIf/ (Authorized Signature/s)
a}Fssf] k|of]hgsf nflu dfq (For Bank's Use Only)
Interviewer’s Declaration:
I hereby certify that I have personally interviewed the customer in line with Bank’s KYC guidelines. The details provided
by the customer matches with his/ her ID and address proof documents.
Interviewer’s Name Job Position Interviewer’s Signature Reviewed By/Signature
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