Date *Date of Birth (DOB) *Select Branch *BIRTAMODE BRANCHILAM BRANCHCHANDRAGADI BRANCHSURUNGA BRANCHDHULABARI BRANCHBUDHABARE BRANCHSHANISCHARE BRANCHSHIVGUNJ BRANCHBHADRAPUR BRANCHCHARALI BRANCHFIKKAL BRANCHBIRATNAGAR BRANCHDAMAK BRANCHKAKARVITTA BRANCHRAJGADH BRANCHMANGALBARE BRANCHDUDHE BRANCHGAURADAHA BRANCHURLABARI BRANCHBIRATCHOWK BRANCHGARAMANI BRANCHBANIYANI BRANCHLETANG BRANCHMAHANANDA CHOWK BRANCHCHARPANE BRANCHGOLDHAP BRANCHSOMBARE BRANCHDURGAPUR BRANCHKHUDUNABARI BRANCHPATHARI SANISHCHAREJHORAHAT BRANCHBHUTAHA BRANCHBHAMARI BRANCHPHIDIM BRANCHINARUWA BRANCHITAHARI BRANCHBAIGUNDHURA BRANCHGAURIGUNJ BRANCHDUHABI BRANCHBELBARI BRANCHKANCHANBARI BRANCHSHREEANTU BRANCHDHARAN BRANCHPATHARI BRANCHRAMPUR BRANCHGender *MaleFemaleOthersAccount Number *Marital Status *SingleMarriedOthersAccount Holder's Name *Mobile Number *Email Permanent Address *Current Address District *District Street/ Tole *Street/ Tole Ward No: *Ward No: Identification Details Date of Issuance Issuing District Other ID Card Details ID Type Date of Issuance Issuing District Expiry Date Nationality *NepaliIndianOtherReligion *HinduMuslimBuddhistOthersPAN No: Family Members (Relation) SpouseFatherMotherGrandfatherGrandmotherSon/daughterDaughter in LawFather in LawMother in LawName, Surname Citizenship Certificate No: Issue Date Family Members (Relation) SpouseFatherMotherGrandfatherGrandmotherSon/daughterDaughter in LawFather in LawMother in LawName, Surname Citizenship Certificate No: Issue Date: Family Members (Relation) SpouseFatherMotherGrandfatherGrandmotherSon/daughterDaughter in LawFather in LawMother in LawName, Surname Citizenship Certificate No: Issue Date Family Members (Relation) SpouseFatherMotherGrandfatherGrandmotherSon/daughterDaughter in LawFather in LawMother in LawName, Surname Citizenship Certificate No: Issue Date Family Members (Relation) SpouseFatherMotherGrandfatherGrandmotherSon/daughterDaughter in LawFather in LawMother in LawName, Surname Citizenship Certificate No: Issue Date Do you have accounts in other banks & Financial Institutions If yes fill upType of Accounts SavingFixedCurrentLoanPurpose of Account *SavingInvestmentPayrollOthersSource of Income *SavingSalaryBusinessOthersOccupation *AgricultureStudentHousewifeBusinessOthersAnticipated Monthly Transaction in number *Anticipated Annual Transaction in number *Anticipated Monthly Transaction in Amount *Anticipated Annual Transaction in Amount *Details of Profession/ Business Please mention estimated annual income if the occupation is agriculture, student, housewife etc.Address Designation Estimated Annual Salary/ Income Net Worth Less than 10 Crore10 to 20 CroreMore than 20 CrorePolitically Exposed Person (PEP) Declaration (If yes, proviode the details)Involved Area Position Existing/ Retired Date of retirement Relation Do you have Beneficial Owner? (If yes provide the details)Relation Contact No: Decleration *I we/hereby declare that all transactions in the account shall remain legitimate and the account shall not be used for the purpose of money laundering and financing of terrorism. If the bank comes to know or suspects that the account being used to process illegal proceeds, I/We shall have no objectives if the Bank reports the account to the concerned authorities. I we/hereby declare that all the information provided are true and correct. Where the information’s have not been specifically mentioned, such information’s are not available or not applicable to me/us.EmailSubmit
