Know Your Membership Form

* Name

Personal Information

* DOB * Citizenship No: Issued Date : (required) Religion : Education :
Office Phone No : Resident Phone No : Mobile No :

Gender : MaleFemale

Your Email (required) :

Parmanent Address

House No/Block : Tole : Ward No : Rural Municipality/Municipality : District : Province :

Temporary Address

House No/Block : Tole : Ward No : Rural Municipality/Municipality : District : Province :

Contact Address

House No/Block : Tole : Ward No : Rural Municipality/Municipality : District : Province :

Extra Information

Resident Type : PermanentTemporary

Voters ID No: Polling Center: Passport No : PAN No :

Family Details

Grandfather's Name : Father's Name : Mother's Name : Spouse's Name :

Marital Status : MarriedUnmarriedDivorced/Others

Family Type Status :

NamePhone/Mobile AgeDate of Birth

1 .

2 .

3 .

4 .

Professional Details

Main Occupation : Main Occupation detail :

Spouse Occupation : Spouse Occupation detail :

Other earning person in family except self and spouse

Name :

Relation :

Occupation : Occupation detail :

If self or other member of family is in high ranking post in politics, administration or organization : YesNo

Name : Relation :
Post :

Income Source Details

Annual Income Source of Family

If the annual Income of family is more than 4 lakhs, the latest Fiscal Year income and it's source should be included

Farmer : Business : Domestic Employee :
Foreign Employee : Other : Total :

Financial Transaction Details

Share : Saving : Other : Yearly Transaction Times : Estimated annual desposit amount : Estimated Loan Transaction :

Business Details

Name of Firm/Company :

Firm/Company Address

State : District : Rural Mcp/Mulcipalty : Ward No : Village/Tole : House No :
Contact Person : Contact Email :

Cooperative Membership Details

Objectives of geting Membership :

Membership in other Coopertives : YesNo

If yes, give details

Name
Membership No

1 .

2 .

3 .

If other family member have got the membership of the other cooperatives : YesNo

If yes, give details

S.N
Name, Surname
Relation
Cooperative Name, Address
Membership No

1 .

2 .

3 .

If you have got the membership of more than one cooperative , give reason

If other family member have got the membership of more than one coopertive, give reason

Whether other member of your family got membership in this cooperative or not : YesNo

If yes, give details

S.N
Name, Surname
Membership No.

1 .

2 .

3 .

Nominee

I maintaining Membership No : at China Trade Multipurpose Co-operative Ltd., hereby given details of the nominee to receive any sum of amount which may be due to me from China Trade Multipurpose Co-operative Ltd. in the event of my death.

Mr./Mrs./Miss : Relation : Permanent Address : Contact Address : Tel./Mobile No : Email :

If the above mention information change due to any reason, I will inform within 35 days of such changes. All the above mention informtion is coreect and true, if false I am ready to face the legal actions.