Sajilo Broker |

Mero Share Registration - Personal Information

First Name*

Middle Name

Last Name*

Nationality*

Gender*

Marital status*

Single Married Others

Father's Name*

Mother's Name*

Citizenship Number*

Citizenship Issue District*

Date of Birth (BS)*

Date of Birth (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

Client ID Number*

Signature*

Photo must be less than 100KB. Accepted extension: .jpg,.jpeg,.png
Signature must be signed by black ink and match with Bank Account Signature

I/We hereby declare that the information provided above is true and correct to the best of my/our knowledge. In case of misrepresentation and/or information provided is proved to be wrong, I/We hereby consent to borne any legal actions and the Depository Participant reserves right to close my/our account. Person in the form must visit our office within 1 month of submission otherwise the account might be deactivated.