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C-ASBA Registration Form: CFJ) BSSF) ljj/0f

This document is a C-ASBA registration form for applying to purchase securities through an initial public offering in Nepal. It collects applicant details like name, address, bank account and demat account information to use the funds in the bank account to purchase securities and deposit any shares received into the demat account. The form authorizes the bank to block funds for the application, process payments for shares allotted, and collect applicable fees on behalf of the issuer company.

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AaSis Cwakoti
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© © All Rights Reserved
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Download as PDF, TXT or read online on Scribd
142 views

C-ASBA Registration Form: CFJ) BSSF) ljj/0f

This document is a C-ASBA registration form for applying to purchase securities through an initial public offering in Nepal. It collects applicant details like name, address, bank account and demat account information to use the funds in the bank account to purchase securities and deposit any shares received into the demat account. The form authorizes the bank to block funds for the application, process payments for shares allotted, and collect applicable fees on behalf of the issuer company.

Uploaded by

AaSis Cwakoti
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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C-ASBA Registration Form

ldlt D D M M Y Y Y Y
zfvf÷Branch=================================== Date

d}n÷] xfdLn] ca pk/fGt x'g] lwtf]kqsf] ;fj{hlgs lgisfzgsf qmddf lwtf]kq vl/b -;fj{hlgs lgisfzg_ ;DaGwL lgb{l] zsf, @)&#
-bf];|f] ;+zf]wg, @)&$ ;lxt_ cGtu{t vl/b ug{sf nflu To; a}+sdf /x]sf] d]/f]÷xfd|f] tn pNn]lvt a}+s vftfdf df}Hbft /x]sf]
/sd k|of]u u/L vl/b ug{ tyf afF8kmfF8 eP kl5 k|fKt x'g] lwtf]kq lgDg lxtu|fxL vftfdf hDdf u/fpg] x'bF f lwtf]kq vl/b k|of]hgsf]
nflu lgDg cg';f/sf] ljj/0f k|of]u ug{sf nflu To; a}+s 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}+ .
tn pNn]lvt ;Dk"0f{ ljj/0f /fd|f];Fu eg{' kg{]5 . cfkm";Fu ;/f]sf/ gePsf] ljj/0f pNn]v ug{] sf]7fdf t];f{] wsf{ tflglbg' xf]nf .
Please complete all details and strike out the non-applicable fields/boxes.
a}+s vftf gDa/
Bank A/C No.
a}+s vftfsf] lsl;d art vftf rNtL vftf* cGo
Type of Bank Account Saving Account Current Account* Others
lgIf]k ;b:osf] kl/ro gDa/ lxtu|fxL kl/ro gDa/
(DP ID) (Client ID)
*cf]e/ 8«fˆ6 vftf afx]s (Except OD A/C)
cfj]bssf] ljj/0f/Applicant's Details
cfj]bssf] gfd
Name of Applicant (Block Letter)
afa'sf] gfd
Father's Name
cfdfsf] gfd
Mother's Name
afh]sf]] gfd
Grandfather's Name
klt÷kTgLsf] gfd
Spouse's Name
;+/Ifssf] gfd -gfafnssf] xsdf_
Guardian's Name (in case of Minor)
sDkgL btf{ gDa/ -;+:yfsf] xsdf_
Company Registration No. Incase of Company)
;+:yfsf] tkm{af6 eP clVtof/ k|fKt JolQmsf] gfd
kb cGo
:yfoL n]vf g+= (PAN No.)

Customer Copy -u|fxs k|lt_


cfj]bssf] gfd
Customer Name

a}+s vftf g+=


Bank Account No.
lxtu|fxL vftf g+=
BOID
C-ASBA /lhi6«]zg g+= cflwsf/Ls b:tvt÷a}+ssf] 5fk
C-ASBA Reg. No. (CRN) (Authorized Signature/Bank Stamp)
kl/ro kqsf] ljj/0f gful/stf÷hGd btf{ (Citizenship/Birth Certificate)
gDa/ hf/L ePsf] 7fpF
Number Place of Issue
hf/L ePsf] ldlt D D M M Y Y Y Y
Date of Issue

:yfoL 7]ufgf÷Permanent Address -kqfrf/ ug{] 7]ufgf eGbf km/s ePdf dfq eg{' xf]nf_
k|b]z g+= lhNnf uf=kf÷g=kf=
Province No. District R.M./Municipality
6f]n j8f g+= Ans g+=
Tole Ward No. Block No.
kmf]g g+= ˆofS; g+=
Phone No. Fax No.

kqfrf/ ug{] 7]ufgf÷Correspondence Address


/fi6«
Country
k|b]z g+= lhNnf uf=kf=÷g=kf=
Province No. District R.M./Municipality
6f]n j8f g+= Ans g+=
Tole Ward No. Block No.
kmf]g g+= df]afOn g+=
Phone No. Mobile No.
ˆofS; g+= kf]i6 aS; g+=
Fax No. P.O.Box No.
O{d]n
E-mail ID

k'gZr M dfly pNn]lvt ljj/0f k|of]u u/L, To; a}+sn] k|bfg u/]sf] /lhi6«]zg gDa/ (CRN Number) pNn]v u/L lwtf]kq vl/b
cfj]bg lbFbf l;l8Pdl;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 jfkt d]/f]÷xfd|f] vftfdf df}Hbft /x]sf] /sd /f]Ssf /fVg tyf afFkmfF8 kZrft\ k|fKt x'g] lwtf]kq jfktsf]
/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}s
+ n] ;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÷gfafns tyf ;+/Ifssf] xsdf cleefjssf] b:tvt
Stamp (For Institution) (Applicant's Signature)

For Bank Use Only -a}+s k|of]hgsf] nflu dfq_


Application Received On -cfj]bg k|fKt ldlt_ :-
Application Received By -cfj]bg k|fKt ug{]_ :-
Authorized By -k|dfl0ft ug{]_ :-

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