SMART LIFE NEPAL PVT.LTD

smartlifenepalpvtltd@gmail.com Switch account

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Smart Life Nepal customer application form

ग्राहक विवरण (Customer Details)

ग्राहकको नाम (Customer Name) *

लिङ्ग (Gender) * Male Female Other

जन्म मिति (Date of Birth in BS) * जन्म मिति (Date of Birth in AD) ग्राहक सम्पर्क नम्बर (Customer Contact Number) *

स्थायी ठेगाना (Permanent Address)

प्रदेश (Province) * Koshi Madhesh Bagmati Gandaki Lumbini Karnali Sudurpashchim

स्थानीय तह (Local Level) * टोल (Tole) * इमेल (E-mail)

पारिवारिक विवरण (Family Details)

बुबाको नाम (Father's Name) * आमाको नाम (Mother's Name) * हजुरबुबाको नाम (Grandfather's Name) * पेशाको विवरण (Details of occupation) * परिवारका सदस्यहरूको संख्या (Number of family members) * Nominee name * Nominee contact details * ग्राहक फोटो (Customer Image) *Upload 1 supported file: PDF, document, or image. Max 1 MB. ग्राहक हस्ताक्षर image (Customer signature) *Upload 1 supported file: PDF, document, or image. Max 1 MB. ग्राहकको नागरिकता (Customer's Citizenship) *Upload 1 supported file: PDF, document, or image. Max 1 MB. हाम्रो कम्पनीको बारेमा तपाईंलाई कसरी थाहा भयो? (How did you know about our Company?) *

ग्राहक पहिचान नम्बर (Customer Identification Number) For Company use only

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