Detail Of Beneficial Owner
Correspondence Address
Permanent Address
Bank Detail
Occupation
Nominee
Gaurdian
Document
Type Of Account / खाताको प्रकार
*
Individual / व्यक्तिगत
Foreign Employement
Minor / नाबालक
*
YES / हो
NO / होईन
Mero Share Service / मेरो सेयर सेवा
*
YES / हो
NO / होईन
Maritial Status / वैवाहिक स्थिति
*
Married / विवाहित
Unmarried / अविवाहित
Gender / लिङ्ग
*
Male
Female
Title / शीर्षक
*
Mr.
Mrs.
Miss.
Minor
First Name / आवेदकको पहिलो नाम
*
Middle Name / आवेदकको बीचको नाम
Last Name / आवेदकको थर
*
Father's Name / बुवाको नाम
*
Grandfather's Name / हजुरबुबाको नाम
*
Mother's Name आमाको नाम
*
Spouse's Name / जीवनसाथीको नाम
*
Son's Name/ छोराको नाम
Daughter's Name / छोरीको नाम
Daughter In Law's Name / बुहारीको नाम
Father In Law
*
Citizenship No. / नागरिकता नम्बर
*
Citizen Issue District / नागरिकता जारी जिल्ला
*
-- Select --
Achham
Arghakhanchi
Baglung
Baitidi
Bajhang
Bajura
Banke
Bara
Bardiya
Bhaktapur
Bhojpur
Chitwan
Dadeldhura
Dailekh
Dang
Darchula
Dhading
Dhankuta
Dhanusa
Dolkha
Dolpa
Doti
Gorkha
Gulmi
Humla
Ilam
Jajarkot
Jhapa
Jumla
Kailali
Kalikot
Kanchanpur
Kapilvastu
Kaski
Kathmandu
Kavrepalanchowk
Khotang
Lalitpur
Lamjung
Mahottari
Makwanpur
Manang
Morang
Mugu
Mustang
Myagdi
Nawalparasi (Pashchim)
Nawalparasi (Purba)
Nuwakot
Okhaldhunga
Palpa
Panchthar
Parbat
Parsa
Pyuthan
Ramechhap
Rasuwa
Rautahat
Rolpa
Rukum (Pashchim)
Rukum (Purba)
Rupandehi
Salyan
Sankhuwasabha
Saptari
Sarlahi
Sindhuli
Sindhupalchok
Siraha
Solukhumbu
Sunsari
Surketh
Syangja
Tanahu
Taplejung
Terathum
Udayapur
Citizenship Issue Date (BS) / नागरिकता जारी मिति ( वि . सं )
*
Citizen Issue Date (AD) / नागरिकता जारी मिति ( इस्वी सम्बतमा )
*
DOB (BS) / जन्म मिति ( वि . सं )
*
DOB (AD) / जन्म मिति ( इस्वी सम्बतमा )
*
PAN No. / प्यान नम्बर
Next
Province
*
-- Select --
Province No. 1
Province No. 2
Bagmati Province
Gandaki Province
Lumbini Province
Karnali Province
Sudurpashchim Province
District / जिल्ला
*
-- Select --
Achham
Arghakhanchi
Baglung
Baitidi
Bajhang
Bajura
Banke
Bara
Bardiya
Bhaktapur
Bhojpur
Chitwan
Dadeldhura
Dailekh
Dang
Darchula
Dhading
Dhankuta
Dhanusa
Dolkha
Dolpa
Doti
Gorkha
Gulmi
Humla
Ilam
Jajarkot
Jhapa
Jumla
Kailali
Kalikot
Kanchanpur
Kapilvastu
Kaski
Kathmandu
Kavrepalanchowk
Khotang
Lalitpur
Lamjung
Mahottari
Makwanpur
Manang
Morang
Mugu
Mustang
Myagdi
Nawalparasi (Pashchim)
Nawalparasi (Purba)
Nuwakot
Okhaldhunga
Palpa
Panchthar
Parbat
Parsa
Pyuthan
Ramechhap
Rasuwa
Rautahat
Rolpa
Rukum (Pashchim)
Rukum (Purba)
Rupandehi
Salyan
Sankhuwasabha
Saptari
Sarlahi
Sindhuli
Sindhupalchok
Siraha
Solukhumbu
Sunsari
Surketh
Syangja
Tanahu
Taplejung
Terathum
Udayapur
VDC-Municipality / गाविस -नगरपालिका
*
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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Next
Same as Correspondence Address / पत्राचार ठेगाना जस्तै
Province
*
-- Select --
Province No. 1
Province No. 2
Bagmati Province
Gandaki Province
Lumbini Province
Karnali Province
Sudurpashchim Province
District / जिल्ला
*
-- Select --
Achham
Arghakhanchi
Baglung
Baitidi
Bajhang
Bajura
Banke
Bara
Bardiya
Bhaktapur
Bhojpur
Chitwan
Dadeldhura
Dailekh
Dang
Darchula
Dhading
Dhankuta
Dhanusa
Dolkha
Dolpa
Doti
Gorkha
Gulmi
Humla
Ilam
Jajarkot
Jhapa
Jumla
Kailali
Kalikot
Kanchanpur
Kapilvastu
Kaski
Kathmandu
Kavrepalanchowk
Khotang
Lalitpur
Lamjung
Mahottari
Makwanpur
Manang
Morang
Mugu
Mustang
Myagdi
Nawalparasi (Pashchim)
Nawalparasi (Purba)
Nuwakot
Okhaldhunga
Palpa
Panchthar
Parbat
Parsa
Pyuthan
Ramechhap
Rasuwa
Rautahat
Rolpa
Rukum (Pashchim)
Rukum (Purba)
Rupandehi
Salyan
Sankhuwasabha
Saptari
Sarlahi
Sindhuli
Sindhupalchok
Siraha
Solukhumbu
Sunsari
Surketh
Syangja
Tanahu
Taplejung
Terathum
Udayapur
VDC-Municipality / गाविस -नगरपालिका
*
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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Next
Types Of Bank Account / बैंक खाताका प्रकारहरू
*
-- Select --
Saving Account
Current Account
Name Of Bank
*
Bank Account Number / बैँक खाता नम्बर (20 digits)
*
Debit Authority
*
Yes
Debit Authority
*
I hereby authorize Jyoti Bikash Bank Ltd to deduct all the De-mat and Mero share service-related charges from the account maintained at the bank.
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Next
Occupation Type / व्यवसायको प्रकार
*
--- Select Occupation ---
Business Person
Farmer
Government Services
House Wife
Others
Private Sector
Public Sector
Retired
Service
Student
Type Of Business / व्यापारको प्रकार
--- Select BusinessType ---
Manufacturing
Service Oriented
Organization Name / संस्थाको नाम
Address / ठेगाना
Designation / पद
Financial Details / Annual Income
Up to Rs.1,00,000
From Rs.1,00,001 to Rs.2,00,000
From Rs.2,00,001 to Rs.5,00,000
Above Rs.5,00,000
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YES
No
Name English / नाम
*
Father Name
*
Relationship / सम्बन्ध
*
Reference Document Type / कागजात प्रकार
*
-- Select --
Citizenship
Passport
Birth Certificate
Citizenship / Passport / Birth Certificate
*
Place of Issue / जारी को स्थान
*
Issue Year
*
Province
*
-- Select --
Province No. 1
Province No. 2
Bagmati Province
Gandaki Province
Lumbini Province
Karnali Province
Sudurpashchim Province
District / जिल्ला
*
-- Select --
Achham
Arghakhanchi
Baglung
Baitidi
Bajhang
Bajura
Banke
Bara
Bardiya
Bhaktapur
Bhojpur
Chitwan
Dadeldhura
Dailekh
Dang
Darchula
Dhading
Dhankuta
Dhanusa
Dolkha
Dolpa
Doti
Gorkha
Gulmi
Humla
Ilam
Jajarkot
Jhapa
Jumla
Kailali
Kalikot
Kanchanpur
Kapilvastu
Kaski
Kathmandu
Kavrepalanchowk
Khotang
Lalitpur
Lamjung
Mahottari
Makwanpur
Manang
Morang
Mugu
Mustang
Myagdi
Nawalparasi (Pashchim)
Nawalparasi (Purba)
Nuwakot
Okhaldhunga
Palpa
Panchthar
Parbat
Parsa
Pyuthan
Ramechhap
Rasuwa
Rautahat
Rolpa
Rukum (Pashchim)
Rukum (Purba)
Rupandehi
Salyan
Sankhuwasabha
Saptari
Sarlahi
Sindhuli
Sindhupalchok
Siraha
Solukhumbu
Sunsari
Surketh
Syangja
Tanahu
Taplejung
Terathum
Udayapur
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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Next
Next
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
*
-- Select --
Achham
Arghakhanchi
Baglung
Baitidi
Bajhang
Bajura
Banke
Bara
Bardiya
Bhaktapur
Bhojpur
Chitwan
Dadeldhura
Dailekh
Dang
Darchula
Dhading
Dhankuta
Dhanusa
Dolkha
Dolpa
Doti
Gorkha
Gulmi
Humla
Ilam
Jajarkot
Jhapa
Jumla
Kailali
Kalikot
Kanchanpur
Kapilvastu
Kaski
Kathmandu
Kavrepalanchowk
Khotang
Lalitpur
Lamjung
Mahottari
Makwanpur
Manang
Morang
Mugu
Mustang
Myagdi
Nawalparasi (Pashchim)
Nawalparasi (Purba)
Nuwakot
Okhaldhunga
Palpa
Panchthar
Parbat
Parsa
Pyuthan
Ramechhap
Rasuwa
Rautahat
Rolpa
Rukum (Pashchim)
Rukum (Purba)
Rupandehi
Salyan
Sankhuwasabha
Saptari
Sarlahi
Sindhuli
Sindhupalchok
Siraha
Solukhumbu
Sunsari
Surketh
Syangja
Tanahu
Taplejung
Terathum
Udayapur
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
*
Achham
Arghakhanchi
Baglung
Baitidi
Bajhang
Bajura
Banke
Bara
Bardiya
Bhaktapur
Bhojpur
Chitwan
Dadeldhura
Dailekh
Dang
Darchula
Dhading
Dhankuta
Dhanusa
Dolkha
Dolpa
Doti
Gorkha
Gulmi
Humla
Ilam
Jajarkot
Jhapa
Jumla
Kailali
Kalikot
Kanchanpur
Kapilvastu
Kaski
Kathmandu
Kavrepalanchowk
Khotang
Lalitpur
Lamjung
Mahottari
Makwanpur
Manang
Morang
Mugu
Mustang
Myagdi
Nawalparasi (Pashchim)
Nawalparasi (Purba)
Nuwakot
Okhaldhunga
Palpa
Panchthar
Parbat
Parsa
Pyuthan
Ramechhap
Rasuwa
Rautahat
Rolpa
Rukum (Pashchim)
Rukum (Purba)
Rupandehi
Salyan
Sankhuwasabha
Saptari
Sarlahi
Sindhuli
Sindhupalchok
Siraha
Solukhumbu
Sunsari
Surketh
Syangja
Tanahu
Taplejung
Terathum
Udayapur
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
*
Guardian Photo
फोटो
*
Guardian Citizenship (Front)
नागरिकता (अगाडि)
*
Guardian Citizenship (Back)
नागरिकता (पछाडि)
*
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