IPAYREMITTAL

Personal Information

First Name

Middle Name

Last Name

Gender

D.O.B

Marital Status

Married

Unmarried

Family Details

Father's Name

Mother's Name

Grandfather's Name

Contact Details

Mobile No.

Email

Temporary Address

Province

District

VDC/Municipality/Sub-Metropolitan/Metropolitan

Ward Number

Street Address

Postal Code

Permanent Address

Province

District

VDC/Municipality/Sub-Metropolitan/Metropolitan

Ward Number

Street Address

Postal Code

Additional Information

Profession

Source Of Income

Are you or your family members politically exposed persons (PEP) or people in influencung position ?

No

Yes (If yes, Specify) Date of retirement

Are you have Beneficial owner?

No

Yes (If yes, Specify & provide Beneficial Owner)

Customer ID Details

ID Type

Issue country

Issue palce

Id number

Issue date

Expire Date

Declaration:

I hereby declare that information furnished herein above is correct and truth to the best of my knowledge and belief. I undertake to inform you of any changes therein immediately. In case any of the information is found to be false, untrue, misleading or misrepresenting, I will be held liable for any legal consequences.
म यहाँ घोषणा गर्दछु कि माथि वर्णन गरिएको जानकारी सही र मेरो ज्ञान र विश्वासको उत्तममा सत्य छ। म त्यहाँ तुरून्त कुनै पनि परिवर्तनको बारेमा तपाईंलाई जानकारी गराउन चाहन्छु। यदि कुनै पनि जानकारी गलत, असत्य, भ्रामक वा गलत वर्णन गरिएको पाएमा, म कुनै कानुनी परिणामहरूको लागि उत्तरदायी हुनेछु।

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