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Customer Name (वित्तीय ग्राहकको नाम)*
Mobile No. (मोबाइल नम्बर)*
Email (सम्पर्क इमेल)*
Province (प्रदेश)* Select ProvinceProvince No. 1MadhesBagmatiGandakiLumbiniKarnaliSudurpashchim
District (जिल्ला)* —Please choose an option—
Municipality (नगरपालिका/गाउँपालिका)* —Please choose an option—
Ward No. (वडा नं.)*
Street (टोल)*
Bank Name (बैंकको नाम)* Select BankAgricultural Development Bank Ltd.Citizens Bank International Ltd.Everest Bank Ltd.Global IME Bank Ltd.Himalayan Bank Ltd.Kumari Bank Ltd.Laxmi Bank Ltd.Machhapuchchhre Bank Ltd.Nabil Bank Ltd.Nepal Bank Ltd.Nepal Investment Mega Bank Ltd.NIC ASIA Bank Ltd.NMB Bank Ltd.Nepal SBI Bank Ltd.Prabhu Bank Ltd.Prime Commercial Bank Ltd.Rastriya Banijya Bank Ltd.Sanima Bank Ltd.Siddhartha Bank Ltd.Standard Chartered Bank Nepal Ltd.Sunrise Bank Ltd.
Bank Branch (बैंक शाखा)*
Complaint Subject (गुनासोको विषय)*
Related Documents (सम्बन्धित कागजात) (If any) [Uploaded file size should not exceed 500kb]
Complaint Brief Description (गुनासोको तथ्य सहितको विवरण)
I hereby declare that the information provided is true and correct. (म / हामीले दरखास्त फारममा उपलब्ध गराएको सूचना तथा जानकारीहरु सत्य र ठिक छ भनि पुष्टी गर्दछु।)
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