cf:jf k|0ffnL cGtu{t lwtf]kq vl/b ug{sf nflu a}+s vftf / lxtu|fxL vftf ;DaGwL ljj/0f cBfjlws u/fpgsf]

nflu cfjZos kmf/fd (C-ASBA Registration Form)

>L glan a}+s lnld6]8 ldlt÷Date M =====÷=======÷==================

========================================= zfvf

d}n]÷xfdLn] ca pk/fGt x'g] lwtf]kqsf] ;fj{hlgs lgisfzgsf qmddf lwtf]kq vl/b -;fj{hlgs lgisfzg_ ;DaGwL lgb]{lzsf,
@)&# -bf];|f] ;+zf]wg, @)&$ ;lxt_ cGtu{t vl/b ug{sf nflu To; a}+sdf /x]sf] d]/f]÷xfd|f] b]xfosf vftf gDa/df df}Hbft
/x]sf] /sd k|of]u u/L vl/b ug{ tyf afF8kmfF8 eP k5L k|fKt x'g] lwtf]kq ;b:o
====================================================================================================================== df vf]lnPsf] b]xfosf] lxtu|fxL vftf
gDa/df hDdf u/fpg] x'Fbf lwtf]kq vl/b k|of]hgsf] nflu lgDg cg';f/sf] ljj/0f k|of]u ug{sf nflu To; a}+sdf cfjZos
Joj:yf ul/lbg' x'g d]/f]÷xfd|f] a}+s vftf tyf lxtu|fxL vftf ;DaGwL ljj/0f ;lxt of] lgj]bg k]z u/]sf] 5'÷5f}+ .
a}+s vftfsf] ljj/0f
vftf gDa/ Vfftfsf] lsl;d art rNtL sn
Account Number Account type Savings Current Call

lxtu|fxL vftfsf] ljj/0f

g]kfnLdf c+u|]hLdf (In English)
lgIf]k ;b:o gDa/ DP ID
lxtu|fxL gDa/ BO ID

cfj]bssf] ljj/0f
cfj]bssf] gfd y/
Applicant's Name
gful/stf gDa/ M Hff/L lhNnf M hf/L ldlt M
Citizenship No Issued District Issued Date
:yfoL n]vf gDa/ sDkgL btf{ gDa/ -;+:yfsf] xsdf_
PAN No. Registration No. (legal entities)
:yfoL 7]ufgf (Permanent Address)
Uff=kf=÷g=kf=÷d=g=kf=
k|b]z lhNnfM
V.M. /Municipality
Province District
/Metropolis
6f]n j8f g+= Ans g+=
Tole Ward No. Block No.
6]lnkmf]g g+= df]afOn g+= O{d]nM
Telephone No. Mobile No. E-mail ID
xfnsf] 7]ufgf (Current Address)
Uff=kf=÷g=kf=÷d=g=kf=
k|b]z lhNnfM
V.M. /Municipality
Province District
/Metropolis
6f]n j8f g+= Ans g+=
Tole Ward No. Block No.
6]lnkmf]g g+= df]afOn g+= O{d]nM
Telephone No. Mobile No. E-mail ID
 Kfl/jfl/s ljj/0f (Please use block letters in English)

a'afsf] gfd
Father's Name
cfdfsf] gfd
Mother's Name
xh'/ a'afsf] gfd
Grand Father's Name
klt÷kTgLsf] gfd
Spouse's Name
;+/Ifssf] gfd -gfafns_
Guardian's Name (Minor)

;+:yfsf] tkm{af6 eP clVtof/ kb

k|fKt JolQmsf] gfd
cGo M
k'gZr M dfly pNn]lvt ljj/0f k|of]u u/L, To; a}+sn] k|bfg u/]sf] /lhi6«]zg gDa/ (CRN) pNn]v u/L lwtf]kq vl/b cfj]bg
lbFbf l;l8P;l;n] k|bfg u/]sf] OG6/g]6df cfwfl/t ;]jf æd]/f] z]o/Æ dfkm{t\ jf To; a}+ssf] zfvfx?df pknAw ef}lts cfj]bg
kmf/fd e/]/ a'emfP afkt d]/f]÷xfd|f] vftfdf df}Hbft /x]sf] /sd /f]Ssf /fVg tyf afF8kmfF8 kZrft\ k|fKt x'g] lwtf]kq afktsf]
/sd s§f u/L lwtf]kq lgisfzg tyf laqmL k|aGwssf] vftf dfkm{t\ lgisfzgstf{ sDkgLsf] vftfdf :yfgfGt/0f (Transfer)
u/fpg ;fy}, To; a}+sn] ;fj{hlgs ?kdf pNn]v u/]sf] lwtf]kq vl/b lgj]bg z'Ns ;d]t ;f]xL vftfaf6 s§f u/L c;'n pk/
ug{ d]/f]÷xfd|f] dGh'/L /x]sf] 5 .

============================ =============================
5fk -;+:yfsf] xsdf_ cfj]bssf] b:tvt
Stamp (For Institution) (Applicant's Signature)

a}+s k|of]hgsf] nflu dfq

For Bank's Use only

Identification Verified Yes No Signature Verified Yes No

Any remarks in account Yes No Acct.–BOID name verified Yes No
BOID verified Yes No Address verified Yes No
Registered in C-ASBA Yes No

___________________ __________________ CRN No.:

Registered by (Maker) Verified by (Checker)