CARD APPLICATION FORM

sf8{ cfj]bg kmf/fd

The Branch Manager >L zfvf k|aGwsHo"
Date ldlt D D M M Y Y Y Y
Nepal Investment Mega Bank Limited g]kfn OGe]i6d]06 d]uf a}+s lnld6]8
........................................ Branch zfvf
Dear Sir dxf]bo,
I/We hereby apply for Nepal Investment Mega Bank’s Card to me/us to be operated through my/our below mentioned account. I/We hereby authorize
the Bank to deduct the applicable charges. d÷xfdL d]/f]÷xfd|f] lgDglnlvt vftfaf6 ;~rfng x'g] u/L g]kfn OGe]i6d]06 d]uf a}+ssf] sf8{ pknAw u/fO{lbg'x'g cg'/f]w
ub{5'÷5f}+ . pQm ;]jfsf nflu nfUg] z'Ns d]/f]÷xfd|f] vftfaf6 s§f ul/lng'x'g d]/f]÷xfd|f] k"0f{ d~h'/L 5 .
Card Type sf8{sf] k|sf/ Debit Card 8]la6 sf8{ Prepaid Card lk|k]8 sf8{ Travel Card 6«fen sf8{

Brand a|f08 Visa le;f Mastercard df:6/ sf8{ Other cGo …………..................................................…..

Currency d'b|f NPR g]=?= USD o"=P;=l8= Other cGo …................................…….....................…..

Installment Basis ls:tfaGbLdf
A/C No. vftf g+= Card Fee sf8{ z'Ns
Lump Sum Basis Psd'i7

Name gfd

Address 7]ufgf

Tel. No. 6]lnkmf]g g+= Mobile Number df]afO{n g+=

e-Mail O{d]n
I/We would also like to request you to issue a supplementary card to the person as detailed below. lgDglnlvt ljj/0f ePsf] JolQmnfO{ k"/s sf8{ hf/L
ul/lbg'x'g ;d]t d÷xfdL cg'/f]w ub{5'÷5f}+ .
Name gfd

Address 7]ufgf

Tel. No. 6]lnkmf]g g+= Mobile Number df]afO{n g+=

Relationship to Principal Applicant Spouse Son/Daughter Parent Others, Please Specify ..............................
d'Vo sf8{wf/s;Fusf] gftf klt÷kTgL 5f]/f÷5f]/L cleefjs cGo, s[kof v'nfpg'xf];\

Photo
Photo
of
of
Supplementary
Principal Applicant
Applicant
d'Vo sf8{wf/ssf]
k"/s sf8{wf/ssf]
kmf]6f]
kmf]6f]

PLEASE SIGN INSIDE THE BOX USING BLACK INK

s[kof aS; leq x:tfIf/ ubf{ sfnf] dl;sf] k|of]u ug'{xf];\

Signature of Principal Applicant d'Vo sf8{wf/ssf] x:tfIf/ Signature of Supplementary Applicant k"/s sf8{wf/ssf] x:tfIf/

Date : ldlt D D M M Y Y Y Y Date : ldlt D D M M Y Y Y Y

FOR BANK’S USE ONLY

Branch :
Name of Staff/Signature
Application Received and Signature Verified by : ............................................................................................................... Date .....................................

Card Center :
Name of Staff/Signature
CMS set up by : .................................................................................................................................................................. Date .....................................

Name of Staff/Signature
CMS Verified by : ............................................................................................................................................................... Date .....................................

Card Number X X X X X X Card Made on D D M M Y Y Y Y

 Terms and Conditions Governing the Card Operation sf8{ ;~rfng ;DaGwL zt{ tyf aGb]hx?
Terms and conditions stated hereunder relate to the usage of the Cards by the Cardholder on her/his designated account number(s). sf8{wf/sn] tf]s]sf] vftfaf6 sf8{
tn pNn]lvt cfjZos zt{x? kfngf u/L k|of]u ug'{kg]{5 .

1 The Card issued is the property of Nepal Investment Mega Bank Ltd. (Referred has Bank hereafter) at all times. g]kfn OGe]i6d]06 d]uf a}+saf6 hf/L ul/Psf ;Dk"0f{ sf8{x?
g]kfn OGe]i6d]06 d]uf a}+s -o;kl5 a}+s elgg] 5_ sf] ;DklQ dflgg] 5 .
2 The Card will be activated only upon the change of PIN (Personal Identification Number) initially issued by the Bank. a}+sn] sf8{wf/snfO{{ k|bfg u/]sf] kl/rofTds gDa/
-lkg_ kl/jt{g u/]kZrft\ dfq sf8{ ;lqmo x'g]5 .
3 The Card and PIN issued to the Cardholder are entirely at the Cardholder’s risk and responsibility. The card is non-transferable. The Cardholder shall not
permit possession of the card or disclose the PIN to any other person. The Cardholder undertakes full responsibility for any transactions made by the use
of the card whether or not made with her/his knowledge or authority. a}sn] hf/L u/]sf] sf8{ / lkgdf lglxt hf]lvd tyf bfloTj ;DalGwt sf8{wf/sdf /xg]5 . sf8{sf] :jfldTj x:tfGt/0f of]Uo
x'g] 5}g . sf8{wf/sn] cfˆgf] sf8{sf] :jfldTj cfkm'afx]s cGo s;}df x:tfGt/0f ug{ Pj+ ;f] sf8{;Fu ;DalGwt kl/rofTds gDa/ -lkg_ s;}nfO{ v'nfpg x'Fb}g . sf8{wf/ssf] hfgsf/Ldf jf ljgf hfgsf/L sf8{af6 x'g] ;Dk"0f{
sf/f]af/sf] bfloTj ;DalGwt sf8{wf/ssf] x'g]5 .
4 If the Card is not collected by the customer within 180 days from the date of issuance, the Bank shall destruct the card and deduct applicable charge from
the account(s) designated by the card holder. a}+sn] sf8{ hf/L u/]sf] !*) lbg;Ddf klg u|fxs sf8{ ;+sng ug{ gcfPdf sf8{ lgliqmo kfl/g]5 / u|fxssf] vftfaf6 lgwf{l/t z'Ns s§f ul/g]5 .
5 The Cardholder shall inform the Bank regarding lost,stolen/misplaced and damage of card. The Cardholder will be held liable for all the transactions re-
ceived prior to this notification. lkg x/fPdf, rf]/L ePdf jf lalu|Pdf To;sf] hfgsf/L a}+snfO{ lbg'kg]{5 . a}snfO{ hfgsf/L x'g' k"j{ ePu/]sf ;Dk"0f{ sf/f]af/x?sf] bfloTj sf8{wf/s :jod\n] Joxf]g'{kg]{5 .
6 The Bank shall debit the account(s) designated by the Cardholder for all transactions initiated by principal & supplementary card including all fees & charges
as per standard tariff of charges. k|d'v / k'/s sf8{af6 x'g] ;Dk"0f{ sf/f]jf/ Pj+ ;f] afkt nfUg] z'Nsx? a}+ssf] z'Ns ;'rL cg';f/ u|fxsn] tf]s]sf]] vftfaf6 s§f ul/g]5 .
7 It is the sole responsibility of the Cardholder to verify the transaction with the account statement on regular basis. Any dispute on the transactions should
be lodged in writing within 15 days of receipt of transaction notification. sf8{wf/sn] cfˆgf] vftfdf ePsf] sf/f]jf/sf] lgoldt ?kdf olsg ug'{kb{5 . s'g}klg sf/f]jf/af6 pTkGg x'g;Sg] ljjfbx?
sf/f]jf/sf] hfgsf/L k|fKt ePsf] ldltn] !% lbgleq a}+snfO{ dgfl;j sf/0f ;lxt lnlvt hfgsf/L u/fO;Sg'kg]{5 . tTkZrft\ k|fKt ePsf bfaL pk/ a}+s pQ/bfoL x'g]5}g .
8 In case of Joint Account(s), all the account operators shall be jointly and severally responsible for all card transactions. ;+o'Qm vftfsf] xsdf sf8{af6 x'g] ;Dk"0f{ sf/f]
jf/x?sf] nflu ;a} vftf ;~rfnsx? ;+o'Qm tyf Psn ?kdf lhDd]jf/ x'g]5g\ .
9 The Bank reserves the rights to cancel the Card so issued to any Cardholder, if the information submitted by such Cardholder is found to be false and
or the Card has been misused. sf8{wf/sn] pknAw u/fPsf] s'g} klg ;"rgf em'¶f Pj+ e|fds kfOPdf jf sf8{sf] b'?kof]u u/]sf] kfO{Pdf a}+sn] hf/L u/]sf] sf8{ s'g}klg ;dodf ab/ ug]{] clwsf/ a}+sdf lglxt
/xg]5 .
10 The Bank reserves the right to terminate, withdraw the privileges or not renew the card at any time without prior notice or disclosing any reason, whatsoever
not acceptable to the Bank. a}+sn] s'g}klg ;dodf sf/0f gv'nfO{ jf ljgf k"j{ ;"rgf sf8{ vf/]hL, sf8{df k|bfg ul/Psf ;'ljwfx?af6 jl~rt jf sf8{ gljs/0f gug]{] clwsf/ a}+sdf lglxt /xg]5 .
11 Use of the Card after notice of withdrawal or termination of the membership is fraudulent and may be subject to legal action by the Bank in accordance with
the prevailing law. ;'ljwfx? Jfl~rt u/]sf] jf ;b:otf vf/]h u/]sf] ;"rgf kl5 cgflws[t ?kdf sf8{sf] k|of]u ug{ kfOg] 5}g / o; lj?4 k|rlnt sfg"g cg';f/ a}+sn] sfg"gL sf/jfxL ug{ ;Sg]5 .
12 The cardholder shall not use the card for any transactions prohibited by Law or Regulatory Authorities and the Bank. In the event of failing to so abide, the
cardholder shall be fully responsible. sf8{wf/sn] sfg'gL jf lgofds lgsfox?n] lgif]w u/]sf sf/f]jf/x?df sf8{ k|of]u ug{ kfpg] 5}g . cGoyf sf8{wf/s :jod\ lhDd]jf/ x'g]5 .
13 Information related to limit of cash withdrawal, fees and charges will be published/updated in the Bank’s official website from time to time and such ad-
dendum or alteration shall immediately applicable in the operation of the card. sf8{ dfkm{t x'g] gub sf/f]af/sf] ;Ldf, sf8{;Fu ;DalGwt z'Ns tyf b:t'/x? a}+ssf] cflwsfl/s a]j;fO6df
k|sflzt÷cBfjlws ul/g]5 / To;/L ul/Psf yk÷36 jf ;+zf]wg sf8{ ;~rfng ;DaGwdf tTsfn} nfu' x'g]5 .
14 The Bank reserves the right to limit cash withdrawal and payment and decide on denomination to be dispensed from Bank’s ATM (Automated Teller Ma-
chine). sf8{dfkm{t ul/g] gub tyf e'QmfgL sf/f]af/sf] ;Ldf / a}+ssf] Pl6Pdaf6 k|bfg ul/g] gf]6sf] b/ lgwf{/0f ug{] clwsf/ a}+sdf lglxt /xg]5 .
15 The Bank shall not be held responsible in any way for non-availability of ATM services or other payment services at Merchant outlets for any reason what-
soever beyond the control of the Bank. a}ssf] sfa'eGbf aflx/sf s'g} sf/0fn] sf8{÷Pl6Pd÷ljqm]tfsf] :yndf /x]sf e'QmfgL pks/0fdfkm{t pknAw x'g] ;'ljwf sf8{wf/sn] k|fKt ug{ g;s]df a}+s s'g} klg
k|sf/n] hjfkmb]xL x'g]5}g .
16 The Cardholder undertakes to indemnify the Bank and to keep the Bank indemnified against all losses, damage, cost or expenses incurred and sustained
by the Bank arising out of Cardholder’s failure to observe any of the terms and conditions mentioned herein. sf8{wf/saf6 dfly pNn]lvt zt{ tyf aGb]hx? kl/kfngf x'g g;s]
sf] sf/0fn] a}+snfO{ x'g] ;Dk"0f{ xfgL gf]S;fgL jf vr{sf] ;f]wegf{ ug{ sf8{wf/s d~h'/ ub{5 .
17 The Bank reserves the right to amend these terms and conditions with or without prior notification to the cardholder and such amendments shall be binding
to the Cardholder. sf8{wf/snfO{ k"j{ ;"rgf lbO{ jf glbO{ dfly pNn]lvt s'g} klg zt{ tyf aGb]hx? a}+sn] h'gs'g} ;dodf klg kl/jt{g ug{;Sg]5, h'g sf8{wf/snfO{ nfu' x'g]5 .
18 The Cardholder will be liable for any kind of violation of foreign currency rules and regulations. ljb]zL d'4f ;DaGwL lgod tyf ljlgodx?sf] s'g} klg k|sf/sf] pnª\3gsf] nflu sf8{wf/s
:j+o hjfkmb]xL x'g]5 .
19 All disputes are subject to the jurisdiction of courts in Nepal. ;a} ljjfbx? g]kfnsf cbfntx?sf] sfo{If]q leq /xL ;dfwfg ul/g]5 .
20 These Terms and Conditions will stand amended if law, government regulations or instructions issued by the Nepal Rastra Bank, necessitate such amend-
ments. Dfflysf ;a} ;t{x? df}h'bf sfg"g tyf g]kfn /fi6«« a}+s4f/f hf/L ul/Psf] lgb]{zgdf kl/dfh{g ePdf, :jtM kl/dflh{t ePsf] dflgg] 5g\ .

DECLARATION pb\3f]if0f
I/We hereby declare that the informations provided above are true and correct to the best of my/our knowledge. In case of misrepresentation and/or the
information provided is proved to be wrong, I/We accept full responsibility of all the consequences. In consideration of Nepal Investment Mega Bank providing
me/us with the card services. I/We hereby declare that I/We have read and understood all the terms and conditions mentioned above. I/We declare that above
mentioned mobile number and e-mail are for my/our exclusive use only. I/We agree to receive PIN in my/our aforementioned mobile number. I/We irrevocable
authorised Nepal Investment Mega Bank to debit my/our aforementioned account for utilization of the service and/or charges/fees incurred for card services as
determined by the Bank from time to time. d÷xfdL of] 3f]if0ff ub{5'÷5f}+ ls dfly pNn]lvt ;Dk"0f{ ljj/0fx? ;fFrf] x'g . olb pNn]lvt ljj/0fx? s'g} sf/0fjz\ unt ePsf] cyjf unt k|dfl0ft ePsf]
cj:yfdf To;af6 l;h{gf x'g] ;Dk"0f{ kl/l:ytLsf] lhDd]jf/ d÷xfdL :jod\ x'g]5'÷5f}+ . ;fy} dfly pNn]lvt df]afO{n gDa/, Od]n d]/f]÷xfd|f] JolQmut k|of]hgsf] nflu k|of]u x'g]5 tyf sf8{ ;]jfsf nflu o; a}+s4f/f k|bfg
ul/g] lkg gDa/ pNn]lvt df]afO{n gDa/df k|fKt ug{ d]/f]÷xfd|f] d~h'/L 5 . g]kfn OGe]i6d]06 d]uf a}+s lnld6]8sf] sf8{ ;]jf pkof]u ug]{ ;DaGwdf o; a}+s4f/f sf8{ ;]jf ;DaGwL dfly pNn]v ul/Psf ;Dk"0f{ zt{ tyf
aGb]hx? /fd|/L k9La'emL :jLsf/ ub{5'÷5f}+ . ;fy} sf8{ ;]jf pkof]u u/] jfkt a}sn] ;do ;dodf lgwf{/0f u/] adf]lhdsf] ;]jf z'Ns d]/f]÷xfd|f] gfddf /x]sf] dfly pNn]lvt vftfaf6 c;'n ug'{x'g d]]/f]÷xfd|f] d~h'/L 5 .

..................................................... ..........................................................
Accountholder’s Signature(s) Stamp as applicable
vftfjfnfsf] x:tfIf/ 5fk cfjZos ePdf
CSD-09/2023