NEPA बहुउद्देश्यीय सहकारी संस्था लि.

Know Your Member (KYM) Form

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Member ID Account No. Date

Personal Details

Full Name नाम नेपालीमा Date of Birth Gender Nationality Citizenship No. Issued District Issued Date Marital Status Education Mobile No. Email

Permanent Province District Municipality/Ward Tole Temporary Province District Municipality/Ward Tole

Occupation Office/Business Name Annual Income Income Source Foreign Employment Country

Name Relation Citizenship No. Mobile

मैले माथि दिएको विवरण सत्य र सही छ। कुनै विवरण झुटो ठहरिएमा संस्थाको नियम अनुसार कारवाही स्वीकार गर्नेछु।

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