Sajilo Broker |

KYC Form - Personal Information

First Name*

Middle Name

Last Name*

Nationality*

Date of Birth (BS)*

Date of Birth (AD)*

Gender*

Beneficial Owner Account No*

Types of Account*

Individual

Is this Minor Account*

Yes No

Citizenship Number*

Citizenship Issue District*

Citizenship Issued Date (in BS)*

Citizenship Issued Date (in AD)*

Passport Number

Place of Passport Issue

Passport Issued Date (in BS)

Passport Issued Date (in AD)

Passport Expiry Date (in BS)

Passport Expiry Date (in AD)

Identity Card

Type of Identity Card

Identification Number

Issuance Authority

ID Issue Date(in BS)

ID Issue Date(in AD)

Country*

Province*

District*

Municipality*

Ward No*

Village/Tole/Street*

Block No.

Phone No.

Mobile No.*

Fax No.

Email*

Nearest Landmark*

Is your Correspondence Address is different than your Permanent Address*

Yes No

Types of Bank Account*

Saving Current

Name of Bank*

Bank Account Number*

Branch*

Occupation*

PAN Number*

Type of Business

Organization Name

Organization Address

Designation

Financial Details

Account Statement

ID No.

Standing instruction for the automatic transactions:

Yes No

Are you Non Resident Nepalese?*

Yes No

Do you want to keep nominee ?*

Yes No

Are you a political or high-ranking person? *

Yes No

Are you related to a political or high-ranking person? *

Yes No

Have you been convicted of any related offence in the past? *

Yes No

Offences referred to in clause (sh) of Section 2 of the Prevention of Money Laundering Act, 2064

Photo*