KYC - Individual

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Basic Details

Person's Details

First Name ^*

Middle Name

Last Name ^*

Mobile No. ^*

Enter 10 digits mobile number

Email ^*

Date of Birth (in B.S.) ^*

Date of Birth (in A.D.) ^*

Recent passport sized photo ^*

Upload

File size should be max. 300KB

Gender ^*

Male

Female

Others

Is this a Minor's Account? ^*

Yes

Guardian's Details (in case of Minor only)

Name of Guardian

Full Address of Guardian

Relationship with Applicant

Contact No. of Guardian

PAN No. of Guardian

PAN must be minimum 9 digits

Recent Photo of Guardian

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File size should be max. 300KB

Official Documents

Citizenship Details

Citizenship Front Side Scanned Image ^*

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File size should be max. 300KB

Citizenship No. ^*

Citizenship Issued From ^*

Citizenship Issued Date (in B.S.) ^*

Citizenship Issued Date (in A.D.) ^*

Grandfather's Name ^*

Father's Name ^*

Mother's Name ^*

Citizenship Back Side Scanned Image ^*

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File size should be max. 300KB

Non Residental Nepalese

Are you residing outside Nepal? ^*

Yes

You are current Resident in ^*

NRN Identification No.

Passport Details

Passport Scanned Image

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File size should be max. 300KB

Passport No.

Passport Issued From

Passport Issued Date

Passport Expiry Date

Address Details

Permanent Address

Province ^*

District ^*

Municipality ^*

Tole ^*

Ward No. ^*

House / Block No.

Phone No.

Location Map ^*

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File size should be max. 300KB

Current Address

Is Your Permanent Address same as Current Address?

Yes

Province

District

Municipality

Tole

Ward No.

House / Block No.

Phone No.

Location Map

Upload

File size should be max. 300KB

In case of living in rent

Are you living in rent?

Yes

Name of Landlord

Contact No. of Landlord

Address of Landlord

Family Details

Family Information

Marital Status ^*

Married

Unmarried

Other

Spouse's Name

Son's Name

separate names by 'and' in case of multiple

Daughter's Name (Unmarried)

separate names by 'and' in case of multiple

Daughter in Law's Name

separate names by 'and' in case of multiple

Father in Law's Name

Mother in Law's Name

Accounts Details

DEMAT Account

Scanned Image of DEMAT Confirmation Letter ^*

Upload

File size should be max. 300KB

Beneficiary ID No. ^*

Enter your 16 digits Beneficiary Owner ID No.

Bank Account

Bank Account No. ^*

Name of Bank ^*

Branch ^*

Type of Bank Account ^*

Savings Account

Current Account

Nominee Details

Do you have a nominee? ^*

Yes

Name of Nominee

Relation

Terms and Conditions

Select Siprabi Securities Pvt. Ltd. branch

Select Our Branch ^*

Self Proclamation

I consent to open my online account and have provided all the genuine information to Siprabi Securities Pvt. Ltd. by filling this form. I will be responsible solely for all the documents and details provided by me. Also I will provide further verification if required and comply with the following Terms & Conditions.

The money used for investment isn't earned through opposing action of Money Laundering Act as per Law of Nepal
I am aware of risks possesed by the Securities Market
I will settle transactions related to the Buying and Selling of Securities within time
I will obey laws related to Securties trading
I am not black listed under Credit Information Bureau

Upload Image of your Signature ^*

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File size should be max. 300KB

Upload Image of your Thumb Prints (Right | Left) ^*

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File size should be max. 300KB

Referreral

Were you referred by someone? ^*

Yes

Referred By (If Any)

Upload Image of Referrer's Signature

Upload

File size should be max. 300KB

Siprabi Securities Pvt. Ltd.

KYC - Individual

Siprabi Securities Pvt. Ltd.

अनुसूची-१२

नियम २९ को उपनियम (१) सँग सम्बन्धित

For Official use Only

Please complete all details and leave out the non-applicable fields.

Basic Details

Person's Details

Guardian's Details (in case of Minor only)

Official Documents

Citizenship Details

Non Residental Nepalese

Passport Details

Address Details

Permanent Address

Current Address

In case of living in rent

Family Details

Family Information

Professional Details

Occupation

Income

Involvement in Securities Trading Investment Company

Political

Conviction with Law

Accounts Details

DEMAT Account

Bank Account

Nominee Details

Terms and Conditions

Select Siprabi Securities Pvt. Ltd. branch

Self Proclamation

Referreral

For Official use Only