Account No.

Account Name

Client Code Branch Code 013

Reference Code 079d50ead3

Personal Account Opening Form

Please complete all the details in CAPITAL letter and strike out the non applicable fields/boxes

Existing Account No. :(if any):

Account Name

Do you have any bank account/s in any other Bank and Financial Institution in Nepal?: No
Have you ever convicted of a crime?: No

Date: April 16, 2020

I/We hereby request you to kindly open my/our account as per details given below
A. Personal Information

Salutation: Mrs Nationality: Nepali

Full Name: Pampha Adhikari
( First Name ) ( Middle Name ) ( Last Name )

Citizenship / Passport 273028 Place of issue: jhor Date of issue: 04/10/2063

No.
Date of Birth: 10/04/1979( AD) Pan No.( if applicable):
Gov. ID No. (if applicable):

Occupation: Other
1. Associated Organization name: Address:
Designation: Estimated Annual Income: Tel. (Office):
2. Associated Organization name: Address:
Designation: Estimated Annual Income: Tel. (Office):
3. Associated Organization name: Address:
Designation: Estimated Annual Income: Tel. (Office):

Grand Father's Name: ram prasad

(Full Name)

Father's Name: som prasad sapkota

(Full Name)

Mother's Name: subhadra sapkota

(Full Name)

Spouse's Name: binod adhikari

(Full Name)

Name of Son(s)/Daughter(s) 1: binayak adhikari

(Full Name)

Name of Son(s)/Daughter(s) 2:
(Full Name)
Name of Son(s)/Daughter(s) 3:
(First Name) (Middle Name) ( Last Name)

Father in Law:
(First Name) (Middle Name) ( Last Name)

Daughter in Law:
(First Name) (Middle Name) ( Last Name)

Permanent Address
House No: Wada No: 1 Street Name:
VDC/MC: tokha municipality District: Zone: Contry: Nepal
Current Address:
House No: Street Name:galalbari
City: kathmandu Contry Nepal
Contact Details:
Telephone Number: Mobile Number: 9841145184
Email: [email protected] P.O.Box: ____________

B. Required for non-resident customer

NRN ID No. ( if applicable):

Local Contact Person's Name:
(First Name) (Middle Name) ( Last Name)

Address: City Phone:

Relationship: ______________________ Email: ________________________

C. Type of Account

Account Type: Saving Account

Specify Product Name: Sanima Nari Bachat Specify Currency of Account: NPR
Do you want Internet Banking Facility? Yes

D. Transaction Summary

Source of Fund: Saving , Investment

Expected transaction per month. Currency: NPR Amount: 100000 No. of transaction: 30
Type/Nature of transaction Cash , Cheque

E. Introduced By

Name:Mrs/Mrs./Ms. Opened under e- Account

Account No.

I/We confirm that applicant(s) is known to me/us.

Signature of Introducer Signature Verified By

F. Operating Instruction(s)/Specimen Signature(s) & Photograph(s)

Name Mrs Pampha Adhikari

Signature of Account Holder(A)

Name

Signature of Account Holder(B)

Photo

Name

Signature of Account Holder(B)

Photo

Name

Signature of Account Holder(B)

Photo

Signing Authority for joint Account: [ ] Anyone [ ] Jointly

Special Instruction:____________________________________________________________________

F. Cheque Request
Please provide me/us or ________________________________________ being my/our agent whose specimen signature appears here below, a
new cheque book containg [___] cheque leaves. I/ We authorize the bank to debit my/our account for necessary charges if I/We fail to collect the
cheque book within 3 months from today.

A/C Holder's Signature Signature Verified by Specimen signature of A/C holder's Agent

For Bank Use Only

Product Code: ________________
Duplication Checked [ ] OFAC List Checked [ ] Resident Account [ ] Yes [ ] No

Interest Rate: ___________ Interest & Tax Frequency: ___________ Tax Rate: ___________
Minimum Balance: ___________ RM Code: ___________ Business Unit: ___________
Key Risk Grade

Data processed by:__________________________________________ Approved by:_____________________

Signature / Photo scanned by:_________________________________ Approved by:_____________________
Cheque book processed by:___________________________________ Approved by:_____________________
A/C opened & Docs. Checked by:_______________________________ Approved by:_____________________
Mandate:I/We hereby have provided you the information, which are correct and true in my/our knowledge. I/we hereby acknowledge that I/we read
and understood the Term & Conditions pertaining to the opening and operation of this account and agree to be bound by the same. I/We further
agree to abide by any amendments to the said Terms & Conditions made by the bank from time to time, with or without notice to me/us. Should I/we
fail to comply with or abide by such terms and conditions and shall there be any damage incurred as a consequence thereof, I/we agree and
indemnity to be fully and entirely responsible.

Terms & Conditions

Where the account(s) is/are opened by more than one person the word “I”, “me” or “my” shall read as “we”, ”us” or “our” in these terms. The Terms
shall bind each of the persons named in the accounts individually (hereinafter referred to as the “Account”) or any one or more or all of the
collectively and all agreements, obligations and liabilities of the customers with the bank shall be joint and several.
1. Minimum Balance
The bank may prescribe minimum balance requirements for opening and/or maintaining Accounts.

2. Withdrawals
The customer will not be allowed to withdraw the funds generally from the account below the prescribed minimum balance. One day prior notice is
required for high value withdrawals set by Bank/Branch from saving accounts. The bank may debit customers’ accounts at any time without prior
notice to rectify any mistakes. The Bank may debit customers’ accounts for any commissions, fees, interest or other charges as per “Standard Tariff
of Charges” of Sanima (STC) or any charges imposed by other financial institution in relation to any account or services.

3. Fixed Deposit
Receipt of Fixed Deposit will be provided at the time of opening Fixed Deposit and must be returned to Sanima at the time of maturity for renewal or
premature of Fixed Deposit. FD premature liquidating charge shall be levied as per STC.

4. Interest Payment
Interest on saving and call accounts are paid on quarterly or monthly basis as applicable after deducting applicable tax on interest. Interest on Fixed
Deposit shall be paid on monthly, quarterly, half yearly or maturity as agreed by Sanima with customer after deducting applicable tax on interest.
Interest payable on any account may be subject to change at bank’ own discretion or as specified by the NRB. However, such changes will be
published in any national dailies/Bank’s website/Bank notice board etc. No interest will be payable by the bank on current accounts in any currency.

5. Bank Balance confirmation certificate

Bank balance confirmation certificate will be provided to the customer upon receipt of written request by Sanima and fee as per STC will be levied.

6. Cheque Book
Cheque book will be provided on different types of accounts as per bank’s policy. The customer may request Sanima to deliver the cheque book to a
third party, however the request should be supported by requisition slip or request letter with name, ID and specimen signature of a bearer. When a
cheque book is issued, customer is responsible for its safe custody at all times and customer will immediately notify the Bank if this or any of the
cheques contained therein, is lost or stolen. The Bank will not be liable for any loss due to payment of any lost or stolen cheques, unless the Bank
had notice of such loss or theft at the time of payment. Uncollected cheque books, which have crossed 90 days, will be destroyed and the Cheque
disposal charge should be levied to the customer as per STC.

7. Account Closure
An account will be closed at the written prior request of the customer. The Bank may however, either, as its own instance or at the instance of any
court or administrative order, or NRB or otherwise, close or freeze or suspend dealing on any of the accounts without prior notice to the customer.
Dissimilar account closing charges will be levied as per STC for different types of accounts.

8. Returned Cheque
A charge will be levied as per STC for a cheque, which is returned owing to insufficient balance in the Account and this will also attract black listing
process as per NRB guidelines.

9. Statement of Accounts
Statement of the Accounts will be provided by Post or electronically or On Demand basis and the frequency of the statement printing will be
determined by the Bank. The customer may request Sanima to deliver the statement to a third party, however the request should be supported by
requisition slip or request letter with name, ID, and specimen signature of a bearer. It is the responsibility of the Account Holder to provide the bank
their correct and full address and any change in their address must be advised to the bank promptly. A fee according to bank’s STC will be levied in
the event if the statement to be posted is returned/undelivered on account of wrong/incomplete address. A fee according to Bank’s STC will be levied
for each duplicate statement and statement older than six months.

10. Miscellaneous
In the event of death of a customer, credit balances will be released to the nominee only against an original or certified copy of death certificate,
relationship certificate with the beneficiary and other documents require by the bank. In absence of nominee, bank may issue 35 days’ notice as it
deems fit or as per prevailing law of the land. Bank may disclose and provide the information relating to customer’s account if requested (written) by
any court or CIAA or NRB or Inland Revenue Office or other legal authority. Withdrawals from and credit to foreign currency accounts shall be
subject to availability of foreign currency notes at the time of withdrawal and subject to prevailing Nepal Rastra Bank and Nepal Government rules
and regulations. The Bank reserves the right to accept or refuse of foreign currency notes for credit to the customer’s account(s). The Bank acts as
the customer’s collecting agent and assumes no responsibility for the realization of any items deposited with the bank for collection. Proceed of
cheques or other instruments deposited with the Bank are not available for withdrawal until collected by the Bank. The bank may at any timer debit
and recover from the accounts the value of any instrument negotiated or purchased by the Bank in the event that proceeds are not received against
the same at any time and/or after receipt of proceeds, the account of the Bank is debited or proceeds recovered from the Bank upon return of the
instrument by the drawee or correspondent of the Bank. The customers are advised to count their cash withdrawals at Sanima’s Counters in front of
Sanima’s Tellers. Sanima shall not be held responsible for any short fall in cash withdrawals that are not counted at Sanima’s counted in front of
Sanima’s Tellers.

11. Notes
The Bank reserves the right to amend the charges, fees and any and/or all term and conditions mentioned herein at its sole discretion without giving
any prior notice. The Bank shall always be entitled without noticed to me to recover from and debit the accounts for any charges, expenses, fees, in
respect of the accounts. The Bank is authorized to reverse credit and debit entries made in error. Any charges debited by the Bank are not
refundable upon closure of any or all of the account(s). The document is an integral part of the terms and conditions of Account opening and Account
maintenance/operation document’s conditions at Sanima. I/We hereby declare that the account shall not be used for any money laundering activities.
Bank person holds every right to block the account/report to law enforcement agency. This agreement entered into by the account holder(s) in
relation to the account are governed by laws of land.

_____________________________

Authorized Signature(s)