ACCOUNT CONVERSION REQUEST FORM

Date:____________________

I would like to convert my existing account into the new account.

Account number (existing)

Client Code_____________________

Account Holder Name:

 Reason for conversion ___________________________________________

I hereby surrender the following existing facility associated with my previous account:

Cheque Book Locker ATM Others____________________________

Please change the nominee of my existing account to new account of the following:

Nominee for locker No:-_

Nominee for fixed deposit No:___________________________________________

Please debit my account by NPR _______________for account conversion (transfer) charge.

New Account No Bank’s product Name: __________________________

Please issue me/us a cheque book containing ______________Leaves.

Updates If any:
Name of Spouse: ______________________________________________________________

Citizenship/Passport/Driving License _____________________________

 Email address: _______________________________________________________________________.

 Contact no: Residential ________________________Mobile No __________________________

Residence Address (in full with house no &ward no):

Zone__________________ District________________ Area _____________________________

Nearest Landmark______________ Ward No _____________House No______.

Mailing Address (in full with house no &ward no):Zone__________________

District________________ Area _____________________________

Nearest Landmark______________ Ward No _____________House No______.

 All other information issame as previous.

  Signing Authority for Joint accounts: Any one /Jointly/Other_________________________________
 Special Instruction If any
____________________________________________________________________
 Signature(s) of applicant(s) also to be used as specimen signature (Please sign with black ink)

Signature of Single/Sole Applicant Signature if Joint Applicant Signature of Joint Applicant

Name__________________________ Name ___________________________ Name______________________

I/We agree to be bound by the terms and conditions set out by Sanima and agree that the account(s) will be governed by and
are subject to the terms and condition. I/We also agree that all deposits that may be placed by me/us with the Bank are subject
to the prevailing rules and regulations of Nepal Rastra Bank and are governed by law in effect from time to time.

…………………………………..

(Signature of A/c holder)

For Banks Use Only

Department No objection Objection Reason for objection Signature of the

dept head
Loan
Marketing
Credit
administration
accounts

Scheme Interest Rate interest Frequency Tax Rate

Minimum Balance

Check, whether the following facilities are deleted from the system of the previous account?

I Banking SMS Banking

Data input by (staff Name) _______________________________signature______________

Scanned By ______________________

___________________________ _____________________ _____________________

Document checked and Prepared by Verified by Approved by