|| Personal Info || SPSA Securities Limited

1.1 Personal Info

First Name *

Middle Name

Last Name *

Username *

Contact No *

Email *

Date of Birth (B.S) *

Date of Birth (A.D) *

Gender *

Male

Female

Other

Nationality *

Citizenship No. *

Citizenship Issued From *

Citizenship Issued Date (in B.S.) *

Citizenship Issued Date (in A.D.) *

Passport No.

Passport Issued From

Passport Issued Date

Passport Expiry Date

PAN No.

1.2 Family Information

Grand Father's Name *

Father's Name *

Mother Name *

Marital Status *

Single

Married

Is this a Minor Account? *

Yes

No

Name of Guardian *

Relationship With Guardian *

Guardian Contact No. *

Guardian Email *

Guardian's Mobile No *

Guardian's Fax

Country *

Province *

District *

Guardian's Address *

Municipality *

Ward No. *

PAN No.

Do you want to keep nominee? *

Yes

No

Name of nominee *

Relationship With Applicant *

Nominee Contact No.

Nominee's Citizenship No. *

Citizenship Issued From *

Age *

Nominee's Citizenship Issue Date(B.S.) *

Nominee's Citizenship Issue Date(A.D.) *

Address *

Country *

Province *

District *

Nominee's Fax

Nominee's Mobile No. *

Nominee's Pan

Nominee's Email

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