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Machhapuchchhre Bank Limited at

Account Maintained Branch

iltWtIilofiffiIes Date:_ l_1.


DD MM
Currency:
gAsH / GHEQUE DEPOSTT REGETPT
Amount
Denomination
Account No. Rs. Ps.
1000x
Account Holder's Name
500x
Amount in Words
100x
50x
ForCheques Only 20x
Drawn on Bank Branch Cheque No. 10x
Amount
1) 5x
2) 2x
3)
1x
4)
Coins
Total
Returned
I here.by declare that source of this transaction is not ftom money launderinq, tenonst
' r! rv' I
financing, drug addiction, human trafickking or any other illegal a&iviiieJ.- Total (NPR)
d wcl qftgfii TFrr q?T Fr{-trrinr, erki{-{l-fi, il{ q-{r+di firn-dR, qrr< ffir r firfur
3FRrEr iFTrqilfir 3T+Er *re 3fl-di ,{Crdi
ilfi |
Name olthe Depositor_
Contact No.

Customer Copy Signature of depositor

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