cg';"rL – %

-bkmf & ;+u ;DaGwLt_

(“A” class Institution licensed by Nepal Rastra Bank)

========================================== -zfvf_ ldlt M ==========================

;fj{hlgs lgisfzg lwtf]kq vl/b tyf /sd /f]Ssf cfj]bg kmf/fd
ldlt ================================ b]lv ldlt =============================== ;Dd lgisfzg x'g] b]xfo cg';f/sf] lwtf]kq vl/b ug]{ OR5f ePsf]n] ;f] sf] nflu of] lgj]bg k]z u/]sf] 5' .

lgisfzgstf{ sDkgLsf] gfd M

lwtf]kqsf] lsl;d M

lxtu|fxL -l8Dof6_ vftf g+= M

cfj]bssf] k"/f gfd, y/ M

Name of Applicant (BLOCK LETTER)

zfvfsf] gfd, 7]ufgf M

/sd /f]Ssf /fVg] a}+s vftf g+= M

l;–cfZjf /lhi6«]zg g+=(C-ASBA Regd. No.) :

lwtf]kqsf] ;+Vof M c+sdfM cIf/dfM

k|lt lwtf]kq vl/b /sd M c+sdfM cIf/dfM

hDdf vl/b /sd M c+sdfM cIf/dfM

pko'{Qmfg';f/ lwtf]kq vl/bsf nflu cfjZos x'g] /sd d]/f] a}+s vftfdf df}Hbft /x]sf]n] pQm /sd /f]Ssf /flvlbg' x'g cg'/f]w ub{5' . lwtf]kq afF8kmfF8 ePkl5 d]/f] gfddf
lwtf]kq afF8kmfF8 x'g] ePdf pQm /sd d]/f] vftfaf6 lgisfzg tyf laqmL k|aGwssf] vftfdfkm{t\ lgisfzgstf{ sDkgLsf] vftfdf /sdfGt/sf nflu d]/f] d~h'/L /x]sf] 5 . ;fy},
To; a}+sn] ;fj{hlgs ?kdf pNn]v u/]sf] lwtf]kq vl/b lgj]bg z'Ns;d]t ;f]xL vftfaf6 s§f u/L c;'n pk/ ug{ d]/f]÷xfd|f] d~h'/L /x]sf] 5 .

===================================== =====================================
5fk -;+:yfsf] xsdf_ cfj]bssf] b:tvt
Stamp (For Institution) (Applicant’s Signature)

(“A” class Institution licensed by Nepal Rastra Bank) lwtf]kq vl/bsf nflu /sd /f]Ssf ;DaGwL cw{s§L -cfj]bgstf{sf] k|lt_
lwtf]kq vl/b ug]{ k|of]hgsf] nflu tkfO{+n] k]z ug'{ ePsf] lwtf]kq vl/b tyf /sd /f]Ssf cfj]bg kmf/fd cg';f/ b]xfo cg';f/ tkfO{+sf] a}+s vftfdf /sd /f]Ssf ul/Psf]
5 . lwtf]kq afF8kmfF8 ePkl5 tkfO{+sf] gfddf afF8kmfF8 x'g] lwtf]kq a/fa/sf] /sd tkfO{+sf] /f]Ssf /x]sf] /sdaf6 lgisfzg tyf laqmL k|aGwssf] vftf dfkm{t\ lgisfzgstf{
sDkgLsf] vftfdf /sdfGt/ ul/g]5 .
lgisfzgstf{ sDkgLsf] gfd M

lwtf]kqsf] lsl;d M

lxtu|fxL -l8Dof6_ vftf g+= M

cfj]bssf] k"/f gfd, y/ M

/sd /f]Ssf /fVg] a}+s vftf g+= M

lwtf]kqsf] ;+Vof M c+sdf M cIf/df M

k|lt lwtf]kq vl/b /sd M c+sdf M cIf/df M

hDdf vl/b /sd M c+sdf M cIf/df M

k|dfl0ft ug]{ clwsf/Lsf] gfd M

kb M
F25/CRNF- 2018

b:tvt M
ldlt M
a}+s÷ljQLo ;+:yfsf] gfd, 7]ufgf / 5fk M