KYC Form - EKTA Cooperative

Personal Information

Date of Birth:

Citizen Number:

Issued Date:

Religion:

Education:

Office No:

Resident Phone No:

Mobile:

Email:

Gender:

Male

Female

Permanent Address

House No:

Tole:

Ward No:

Rural Municipality:

District:

Province:

Temporary Address

House No/Block:

Tole:

Ward No:

Rural Municipality/Municipality:

District:

Province:

Contact Address

House No/Block:

Tole:

Ward No:

Rural Municipality/Municipality:

District:

Province:

Extra Information

Resident Type:

Voters ID No:

Polling Center:

Passport No:

PAN No:

Family Details

Grandfather's Name:

Father's Name:

Mother's Name:

Spouse's Name:

Marital Status:

Married

Unmarried

Divorced/Others

Additional Details

Family Type:

Name

Phone

Age

Date of Birth

Professional Details

Main Occupation:

Spouse's Occupation:

Describe Main Occupation:

Describe Spouse's Occupation:

Other Details

Other earning person in family (except self and spouse):

Name:

Relation:

Occupation details:

If self or other member of family is in high ranking post in politics, administration or organization:

Yes

Name:

Relation:

Post:

Income Source Details

If the annual Income of family is more than 4 lakhs, the latest Fiscal Year income and it's source should be included

Financial Transaction Details

Yearly Transaction Times

Estimated Annual Deposit Amount

Estimated Loan Transaction

Business Detail

Cooperative Membership Details

If other family member have got the membership of the other cooperatives:

Yes

If yes, give details:

Name

Relation

Cooperative Name & address

Membership No

If you have got the membership of more than one cooperative , give reason

If other family member have got the membership of more than one coopertive, give reason

Whether other member of your family got membership in this cooperative or not:

Yes

Nominee

I maintaining Membership No : at EKTA Multipurpose Co-Operative Ltd., hereby given details of the nominee to receive any sum of amount which may be due to me from EKTA Multipurpose Co-Operative Ltd. in the event of my death.

If the above mention information change due to any reason, I will inform within 35 days of such changes. All the above mention informtion is coreect and true, if false I am ready to face the legal actions.

KYC Form - EKTA Multipurpose Co-Operative Ltd.

Income Source Details

Financial Transaction Details

Business Detail

Cooperative Membership Details

Nominee

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