Bhat-Bhateni Super Market & Departmental Store Pvt. Ltd.

Cha -1-58, Bhat-Bhateni, P.O. Box No.: 320, Kathmandu, Nepal Ph: 977-1- 4419181, 4413825, 4420240 Fax: 00977-1-4420240

Application for “BHAT-BHATENI CLUB “ Consumer Loyalty Program

Simply fill in the loyalty card application form below. You will receive your own loyalty card and become a member of
our loyalty program and you will start to collect points, freebies and special offers each time you shop at Bhat-Bhateni
Super Market & Departmental Store P. Ltd (BBSM) through your Bhat-Bhateni Club Card. Turn your everyday shopping
into more points and more freebies you get.

Name Mr / Mrs / Miss

Home Address

Name of Business
Photo
Address

Home Telephone Number

Office Telephone Number

Mobile Number

Email Address @

Date of Birth / /
(dd/mm/yyyy)

Date of Anniversary

Number of Family Members

From time to time BBSM and other carefully selected companies will use the information provided through the application
form of “ Bhat-Bhateni Club Card” to direct special offers on products or services to your attention that are hoped to be
of interest to you.

Do you agree to allow BBSM and other carefully selected companies and organizations to disclose such information?

I Agree I Disagree

I have read and understood the conditions of the Bhat-Bhateni Club Card and the application is correct to the best of my
knowledge.

Signature :

Date :

Card No. :
Issued Date : / / (dd/mm/yyyy)

Branch Office: Narayangopal Chowk, Maharajgunj,Chakrapath, Ph.: 977-1-4650730, 4650731, 4650732, Fax: 977-1-
4650733
E-mail: bbstore@wlink.com.np Web: www.bbsm.com.np