Date: 2020/08/03

Personal Information
Full Name GOKARNA GHIMIRE
Contact No. 9851123270
Email gokarnaghimiregg@gmail.com
Date of Birth 1992/08/12 AD
2049/04/28 BS
Gender Male
Nationality Nepali
Citizenship No. 381078/444
Citizenship Issued From Kapilvastu
Citizenship Issued Date 2008/10/12 AD
2065/06/26 BS
Passport No.
Passport Issued From
Passport Issued Date
Passport Expiry Date
Beneficiary No. 1301070000464157
PAN No. 108467899
Is Minor Account? NO
Are you Residing Outside Nepal? NO

Family Information
Grandfather's Name HUMA KANT UPADHAYA
Father's Name MADHAV PRASAD GHIMIRE
Mother's Name MEENA GHIMIRE
Marital Status Married
Spouse's Name SARIKA ADHIKARI
Father‐in‐law Name KHIMLAL ADHIKARI
Mother‐in‐law Name SHANTA ADHIKARI
Son's Name
Daughter's Name

Permanent Address
Country Nepali
Province Province 5
District Kapilvastu
Municipality KAPILVASTU
Ward No. 3
Tole TILAURAKOT
House/Block Number
Phone Number
Fax
Daughter's Name

Permanent Address
Country Nepali
Province Province 5
District Kapilvastu
Municipality KAPILVASTU
Ward No. 3
Tole TILAURAKOT
House/Block Number
Phone Number
Fax

Current Address
Country Nepali
Province Province 5
District Kapilvastu
Municipality KAPILVASTU
Ward No. 3
Tole TILAURAKOT
House/Block Number
Phone Number
Fax

Bank Account Details

Type of Bank Account Saving Account
Bank Account No. 16900089482C
Name of Bank RASTRIYA BANIJYA BANK
Address of Bank TIA AIRPORT

Occupation
Occupation Type Government
Business Type Service Oriented
Organization's Name NEPAL AIRLAINES
Address KANTIPATH KATHMANDU
Designation Employee
ID no. of Employee 33263M
Estimated Annual Income 500001 to 1000000
Involvement in Investment Companies NO

Naasa Securities Branch Kathmandu

I consent to open my online account and have provided all the genuine information to Naasa Securities Company
Limited 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 Terms & Conditions.

* I have read and understood the condition above and agree to create Online Trading Account.
* I have read and understood the condition above and agree to proceed forward.

Applicant's Name GOKARNA GHIMIRE

Involvement in Investment Companies NO

Naasa Securities Branch Kathmandu

I consent to open my online account and have provided all the genuine information to Naasa Securities Company
Limited 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 Terms & Conditions.

* I have read and understood the condition above and agree to create Online Trading Account.
* I have read and understood the condition above and agree to proceed forward.

Applicant's Name GOKARNA GHIMIRE

Referred By NAVA RAJ BANIYA

Selfie carrying your National Identity Card

Citizenship Front

Citizenship Back
Citizenship Back

Signature Image