Jyoti Capital Limited

Province *

District *

VDC / Municipality *

Tole / टोल *

Ward No / वार्ड न*

Block No / ब्लक नं

Phone No / फोन नम्बर

Mobile No / मोबाइल नम्बर(10 digits) *

Email / ईमेल *

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Same as Correspondence Address / पत्राचार ठेगाना जस्तै

Province *

District / जिल्ला *

VDC / Municipality *

Tole / टोल *

Ward No / वार्ड न *

Block No / ब्लक नं

Phone No / फोन नम्बर

Mobile No / मोबाइल नम्बर(10 digits) *

Email / ईमेल

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Types Of Bank Account / बैंक खाताका प्रकारहरू*

Bank Account Number / बैँक खाता नम्बर (20 digits)*

Name Of Bank *

Name Of Branch *

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Occupation *

Bussiness Type

Organization Name

Organization Address

Designation

Financial Details*

Involvement in companies for security trading ?

Politically Exposed Person?*

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Politician Or High Ranking Official

Name of concerned Politician or high ranking official

Relation to Politician or HighRanking Official

Beneficiary Name

Beneficiary Relation

Felony Details

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YES No

Name English / नाम*

Father Name *

Relationship / सम्बन्ध *

Reference Document Type / कागजात प्रकार*

Citizenship / Passport / Birth Certificate *

Place of Issue / जारी को स्थान*

Issue Year *

Province *

District / जिल्ला *

Phone No / फोन नम्बर

Mobile No / मोबाइल नम्बर*

Email / ईमेल

Pan No / प्यान नम्बर

Nominee Photo
फोटो*

Nominee Thumb Prints
थम्ब प्रिन्ट*

Nominee Signature
हस्ताक्षर*

Nominee Birth Certificate / Citizenship (Front)
जन्म प्रमाणपत्र वा नागरिकता (अगाडि) *

Nominee Birth Certificate / Citizenship (Back)
जन्म प्रमाणपत्र वा नागरिकता (पछाडि) *

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First Name / नाम *

Middle Name / अभिभावक नाम

Last Name / अभिभावक थर *

Relation With Applicant *

Father Name*

Grandfather Name *

Spouse Name

Citizenship No./ नागरिकता नम्बर *

Address / पत्राचार गर्ने ठेगाना

District / जिल्ला *

VDC-Municipality/ गाविस - नगरपालिका *

Block No / ब्लक नं *

Ward / वार्ड न *

Phone No / फोन नम्बर

Mobile No / मोबाइल नम्बर*

PAN No / प्यान नम्बर

Email / ईमेल *

Citizenship Issued District/नागरिकता जारी जिल्ला *

Citizenship Issue Date(BS) / नागरिकता जारी मिति ( वि . सं )*

Citizenship Issue Date(AD) / नागरिकता जारी मिति ( इस्वी सम्बतमा )*

DOB(BS) / जन्म मिति ( वि . सं ) *

DOB(AD) / जन्म मिति ( इस्वी सम्बतमा ) *

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Applicant Photo
आवेदकको फोटो *

Citizenship of Applicant (Front)
नागरिकता (अगाडि) *

Citizenship of Applicant (Back)
नागरिकता (पछाडि) *

Location Map of Applicant Residence
आवेदकको घरको स्थानीय नक्शा *

Applicant Signature
आवेदक हस्ताक्षर *

Applicant Thumb Print
आवेदकको ल्याप्चे *

Applicant with Citizenship *

Sample Image*

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