r sdrffi*atur.)fr. · 3nqufr-qq 5iffet[ (fr{rq r

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3nqufr-qQ (fr{rq R<, *i sqfr{q (1) drr wFeral 5IffET[ sEcuHrnES** qt=dfrfi qffi qP{qq kd{sr Deta ils of Natural Person qr6o i.' uin rr+r : fola : Client'sfuc No.: Reference No.: Date : ro vdkd {qqt ffictur 1rNur ud' qne' t wrqtrr vf6r{ dr{Lrdr t€fur ERtq rril' q,t6rrn tfr'rr-6i mfttE &er r Please complete all details and strike out the non-applicable fields/boxes. Sdrffi*atur.)fr. Sweta Securities (P.) Ltd. 5revr* fufqq*f qtci FP Size Photo (Recent) (qTiw) qrq Name rin B:C,. -:i:el ffq trr- rc.q. s. c Udtt, L I 3 :f . ,\ ll KY Gender rr&q-n Natio n alitv MIqrdr{. Beneficiary ID No Citizenship No. lssue District qrtr fuk lssue Date ffi qnr a]fil{ft1 qreTrgr il'q I tt tttl rllrfi +€-r a Permaneni Accolrt Nc lPAN) +{t{Hrfuq ffi zaqT qfuqq!-{ c. r i{nrr ldentification No. and address (ln case of NRN) tqr : Country rtT.gT. /q.qT.,/ g'.q.T.cT. /q.q.gT. Rural Municipality/Municipalitl Sub Metropolitan city/ Metropolitan city *q: Tole : 'ifi-c : E-mail lD stqr : Province k@r District z[€I d.: Ward No.: ffiq;i.: Telephone No. *qrrq i.: Mobile No.: stqr k<r District Province etd Tole ffic;t.: Telephone No rtT.qT. ,/{.qI. /g.q.q. gT. ,/q.q. gT. Rural Municipality/Municipality/ Sub Metropolitan city/ Metropolitan city zt-fi i'.: Ward No. q+ d.: Block No. Page 1 of4 rfr{{+i erfir (For Official Use TIT;T m, Nepalese n 3{=I l-J Others n (Permanent Addressf

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Page 1: r Sdrffi*atur.)fr. · 3nqufr-qQ 5IffET[ (fr{rq R

3nqufr-qQ(fr{rq R<, *i sqfr{q (1) drr wFeral5IffET[ sEcuHrnES** qt=dfrfi qffi qP{qq kd{sr

Deta ils of Natural Person

qr6o i.' uin rr+r : fola :

Client'sfuc No.: Reference No.: Date :

ro vdkd {qqt ffictur 1rNur ud' qne' t wrqtrr vf6r{ dr{Lrdr t€fur ERtq rril' q,t6rrn

tfr'rr-6i mfttE &er r

Please complete all details and strike out the non-applicable fields/boxes.

Sdrffi*atur.)fr.Sweta Securities (P.) Ltd.

5revr*fufqq*f qtciFP Size Photo

(Recent)

(qTiw)

qrq

Name rin B:C,. -:i:el

ffq trr- rc.q. s. cUdtt, L I 3 :f . ,\ ll

KYGender

rr&q-nNatio n alitv

MIqrdr{.Beneficiary ID No

Citizenship No. lssue District

qrtr fuklssue Date

ffi qnr a]fil{ft1 qreTrgr il'q

I tt tttl

rllrfi +€-r aPermaneni Accolrt Nc lPAN)

+{t{Hrfuq ffi zaqTqfuqq!-{ c. r i{nrrldentification No. and address (ln case of NRN)

tqr :

Country

rtT.gT. /q.qT.,/ g'.q.T.cT. /q.q.gT.Rural Municipality/MunicipalitlSub Metropolitan city/Metropolitan city

*q:Tole :

'ifi-c :

E-mail lD

stqr :

Provincek@rDistrict

z[€I d.:Ward No.:

ffiq;i.:Telephone No.

*qrrq i.:Mobile No.:

stqr k<rDistrictProvince

etdTole

ffic;t.:Telephone No

rtT.qT. ,/{.qI. /g.q.q. gT. ,/q.q. gT.

Rural Municipality/Municipality/Sub Metropolitan city/Metropolitan city

zt-fi i'.:Ward No.

q+ d.:Block No.

Page 1 of4

rfr{{+i erfir (For Official UseTIT;T

m,Nepalese

n 3{=Il-J Others

n

(Permanent Addressf

Page 2: r Sdrffi*atur.)fr. · 3nqufr-qQ 5IffET[ (fr{rq R

qk{rCrr ${Frff-+1 HTflr tat-i q5.r qWI QrT .rd qf+il (Details of Family Members)

gqrd fl-qFather's Name(ln Block Letter)

qrffi il-qGnand Fathe/s Name . .. .

Bil-CrdqH

Mothe/s Name

qfr/kffi qrq:' : : : I i :

Spouse's Name :,riXil .:!...:::: ,r..:,i ,,i;:.t: :t:i::.' r..,,::l ,.,,. . . . .. : . ......... i::il ..,iil;:;l ::ii;;::'..

milq

Son's Name

rirt-+]mqtqffiao)

Daughter's Name

garffi mr

Daughter's in Law's : : i

Name

Father in Law'sName

':Trrurat erslVother in Law'slrla..a ;

't\ailte

*+ qmr+r fdkq :

Types of Bank Account

a? crcr rrq{.BankAccount Number:il+ qlfl \rd[ ffi m{ r }qj]- .

Name & Address of Bank :

tqn :-

Occupation

qTWT+I IZFR :

Types of Business

{rsndr Erc : }rnmOrganization's Name : AddresstR : 4-{iqrtr4r e-ow 5+iq-tr gicqrN" T.:

^{ Em^l^',^^\Designation : , " , ', ,, , ' ,., (lD No of Employee)

Page 2 ot 4

t-t q=rf, qrf,ILJ 5sv61g Account

q"-fr qrdrCurrentAccount

i-+r, n T*ftService: - Govt.. ::::,::':. ::

r-'l qrc|-tu gusinessperson

fYqrffStudent

n

- lVlanufacturing

Page 3: r Sdrffi*atur.)fr. · 3nqufr-qQ 5IffET[ (fr{rq R

ilffi+ k+rur :

Financial Details

?F'ftCl-( Il-r{FEI efq k{(qf fransaction related additionalinformation)

1. qrqfi-+i *tftiwT f] k" tr qrr I wq sdq rrffiqq-ar ftrfrq-e ffirm Frq-frfl +rtsT{ {+ qia} : fu f] sq qt 6rq-ffi iT{ : ..........

t. ffir€ Q-qt E{iT +< tgrwor furr+l k. +l or@qr r51 q\r+]q r +" n S nftrer{ qfu( ffi rri Eq s*qn elft( r;i}ei-€ a.rqftqr i{(t-{lnvolvement in lnvestment companies which were established for securities trading

tqqqr t6ra e-dfuq-+1 kfl"r sdnq ,it ct t ([ yes mention below)

e-flg1 +( : q+srft+ qrisTft aq-szcrft8Tk+ ilnff cfrs-{ tf( r{rgt Rrdq{ 6rt-{R

R.

trtr

urf,.s qis.

iF-rqfi-d {rq :

Name of the Company

rK:Designation

ktrr{gr {

ftsr+-s1frtA(ar€r*ffir

s-{ i

EEtaTct ed+l a6'qT

qTIT/SR :

Name/Surname : (ln Block letter)

ffie+vrrai' (rtffiI . .. .

Relationship with applicant : : .

q-trqn arnqT : :

Correspondence Address :

tqr: gter: :

Country: Province :

kwr:District

zt6I ,i.: fqrdF{ q.:

Ward No.: Telephone No.:

Eqrqq i: ilqrfi q.:

Fax No.: tt/obile No.:

r-sr1fi qqr q.' ftc :

PAN No.: E-mail lD :

rtT. gI. / iT. gT. /v.q.T. gT. / q.n. qT

Rural Municipality/Municipality/Sub Metropolitan city/Metropolitan city

d-rer-+-+l 6firq{-(Guardian's Signature

6r{', sSlSrS GSt(crn6) T4{IrLocation Map

Site Map tn

From main Road Street............ the distance of the Residence is meters

Page 3 of 4

slrq-+1 trqr taff:+ k*q / lncome Limit (Annual Details)

n t. {,oo,ooo (q n E. {,oo,oo1 tfu t. 1o,oo,ooo TrErt

- Upto Rs. 5,00,000 - From Rs. 5,00,001 to Rs. 10,00,000 n €. 1o,oo,ooo t1;q1 ffiAbove Rs. 10,00,000

{l*{TftFDirectorx tr 'qla6rft

Shareholderaffi:Employee

,tl #+rNo

3{.q

Others

{,Yes

q-qrftr+rfr

Executive

ffic

teri[-+i k.l-{"r 1q5qK+7f{ftrcil+i FF'qr qH) Guardian's Derairs (rn case of Minor/tnteilectuaily Disabted onty}

Page 4: r Sdrffi*atur.)fr. · 3nqufr-qQ 5IffET[ (fr{rq R

+ ilcri sr qq res qfu'61g-q r

R. + ilw-{ {rq+td-6 qr.s=q qfiE qffi s{r $rqftq ETqq ?

w-Ehrd 6qftfuq7wq q(eT qftr+laqrq'

r. + dcr$ ffir+rfr qfu q r

koftr+rft qffi crq

v. * aw* krTiffir d u:rqa a6qqi ffi rfitm gq qq-a] q r

uwk r1k+-c.r irft qrs"eftsr kflrT qq, ioiv ai Equr t 6I qos cql q$fuqar 6{Tf,[a; w< aqqr rfr-q rrfaE

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1. q76{t& fffia qftffir eiitr gq}.r.r+ r+q qrq-fr tTkqrrlTqr-ffS v-alo-+ ary fu,rftf, qrt'q rrt?ir et +{ r

i. 1'trnlcaqr qtiqm] qqrdlqi f,clga qlfqqs] HrE,ils]qmflT q I

i. +r,,6rfri qftE rrt-*T irdq{6i'qrc-d-dr TmT-fi fu{ frt aTrf

frt+\'+i 6q-q f\T rt q r

x. qr6.ftA ftrjiqr q-rE;di defl q"q g-qfeil hqq 4rfld{aircl-qlT rrfq

r

t. q',/6rfr awf q+m a"T-+l Erdil t-{Hr €+t ez*q r

S. $s,TfA sl,h]rT ,rdi .qrc,:eitft frq-RuT qq, loev t qA.

it-."-Cl.I ;-rE d.rEi ,laqraf1 c?n ffiql{ efifr-flz qTT !f-q

,T..ri6I li==r, . +r:i aitT ii:fiTqrf,-str ar.:-#qr5 gcq4l----\ltrt !,j tt .,J,1 I

rg. F€q'ftqfg q1 qtr r{.nrt'l cqft qi6 rida} arturqlEinllar* ffitl-qr ar.q flahq *fli{ s-Fq-ffderr q-R-{ ft..€rgE-{qt' qtrqR a qfrq{ Tld i-tl,,6rt't r=qt q r

1. ffi mrric+-dt-$r a-oqr qrrfr+-dr+r e-rfiuTq-Tqt cltrffi r

l. r.q tqr+1 qr.rft.fdr Fqrqr qrqr}i+} sftffrft r

t. ilfie-+-+r F6-qT q-1qrm defl (rqtq?r e++]sB r

Y +F-a-fr vieia r+q €r rra;eft aFlulrd I

{. 3rrff +r aq wer* itrtri d-<r myiaftrfi

r

q. fr'-ft-+?ir a-filsfi aqr sila qrr+r'n-rem.a} trftlefi aen +6rqrc I

rg ai ff{rrFgr Et'lTtt {H uExT EriqTt qffaqqqrqi' skft{fi r

qtft{ sdfrka foatul 6qq rq {}+1 < el kq-{q-q[ E* -<o q\ +raa E"*fu-c vqar. eurger r t/We herebyacknowtedge thatthe above disclosed details are true. I further hereby consent to bear any legal actions in case any false o.isclosure ofinformation related to me/us.

eifA qlc Thumb print

qtqi nisht 4I{T Left

qril.F-d 6QreRClient's Signature

q{ rri:

iTr[, elt :

Y(:

ERTElt

tufr:

fuqtrftK a.-dh Errrr: ....

rqrfrrfr .ri :

iTq, q-{

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i5'rqiurt ffi;rr*t ilFr (For Official Use)