UnionPay International Co., Ltd.

Anti-Money Laundering Questionnaire（102）

Anti-Money Laundering (AML), one of the major components of the UnionPay International Risk Management System, aims to
prohibit the use of UnionPay International’s network for laundering money sourced from illegal activities in any jurisdiction or for
terrorism financing. UnionPay International has implemented Anti-money Laundering and Counter-terrorism Financing Program
(AML Program)
This questionnaire is a part of AML Program that is used by UnionPay International to review the AML procedures and activities of
our members.

Please complete this questionnaire in English and return it to UnionPay International.

This questionnaire must be signed by the authorized person in your organization.Please fill out additional forms for different types of
business (acquiring or issuing) or different areas of business (countries or regions) provided that the contact information is different.

Section 1 - General Information

Legal Name: Nepal Investment Bank Ltd.
Legal Address: Ward no:1, Kathmandu Metropolitan City
City: Kathmandu Country: Nepal
AML Contact
Full Name: Mr. Ms. Bandana Thapa
Department: Compliance Title: Chief Compliance Officer
Phone: +977-1-4441110 Email: [email protected]
The Person Completing the Questionnaire
Full Name: Mr. Ms. Supriya Khadka
Department: Compliance Title: Compliance Officer
Phone: +977-1-4441110 Email: [email protected]
Legal Representative
Full Name:       Nationality:      
Date of Birth:       ID Type:      
ID No.:       Exp. Date：      
Principal Person
Full Name:       Nationality:      
Date of Birth:       ID Type:      
ID No.:       Exp. Date：      
Signatory
Full Name:       Nationality:      
Date of Birth:       ID Type:      
ID No.:       Exp. Date：      
Shareholder

© UnionPay International Co., Ltd. All Rights Reserved. 2017 Page 1 of 7

Total number of shareholder: 2,10,720
Please list the following information of all substantial shareholders holding ≥5% total shares:
Nationality Shareholding Date of Birth ID Information (Individual Only)
Full Name
/Location Ratio (Individual Only) Type Number Exp. Date
Rastriya Beema
kathmandu 12.42%             13226179      
Company
Mahalaxmi
Investment Pvt Kathmandu 7.31%             7784152      
ltd
Chaaya
Investment Pvt Kathmandu 6.79%             7233096      
Ltd
K.U.P
Investment Pvt Kathmandu 6.47%             6888604      
Ltd
Sophia
Investment Pvt Kathmandu 6.15%             6544214      
Ltd

*Additional sheets should be attached if there are more Shareholders.

Ultimate Beneficial Owner (UBO)1

Please list the following information of all UBOs holding ≥25% aggregated shares:
Date of Birth ID Information (Individual Only)
Full Name Nationality/Location
(Individual Only) Type Number Exp. Date
None                              
                                   
                                   
                                   
*Additional sheets should be attached if there are more UBOs.

Board of Directors
Please list the following information of all members of the Board of Directors:
ID Information
Full Name Title Nationality Date of Birth
Type Number Exp. Date
Mr. Prithivi
Chairman Nepalese 14-Aug-1954 Passport 07442404 1-Jun-2024
Bahadur Pande
Mr. Prajanaya 20-May-
Director Nepalese 11-Feb-1953 Passport 07384341
Rajbhandary 2024
Mr. Surya
24-Sep-
Prakash Lal Director Nepalese 15-Mar-1953 Passport 06722231
2023
Shrestha
Mr. Kabi 17-Jul-
Director Nepalese 16-Jul-1985 Passport 10469783
Tibrewala 2027
Mr. Niranjan Lal Public Nepalese 28-Nov-1953 Passport 09269589 1-Nov-2025

1
Ultimate Beneficial Owner refers to the natural person(s) who ultimately owns or controls an entity and/or the natural person on
whose behalf a transaction is being conducted. It also includes those persons who exercise ultimate effective control over a legal
person or arrangement.

© UnionPay International Co., Ltd. All Rights Reserved. 2017 Page 2 of 7

 Shrestha Director
Mr. Bhuwaneshwar Public 27-Aug-
Nepalese 12-Oct-1957 Passport 09974196
Prasad Shah Director 2026
Mr. Mohan Madan Independent 29-Apr-
Nepalese 15-Dec-1948 Passport 05926341
Budhathoki Director 2022
                                         
                                         
                                         
                                         

*Additional sheets should be attached if there are more members of Board of Directors.

Senior Executive Officers

Please list the following information of all members of Senior Executive Officers:
ID Information
Full Name Title Nationality Date of Birth
Type Number Exp. Date
Chief
Mr. Jyoti 30-Jun-
Executive Nepalese 10-Jun-1963 Passport 06562842
Prakash Pandey 2023
Officer
Deputy
Mr. Bijendra
General Nepalese 22-Feb-1964 Citizenship 12710 NA
Suwal
Manager
Assistang
Mr. Rabin
General Nepalese 20-Mar-1970 Citizenship 3373 N/A
Sijapati
Manager
                                         
                                         
                                         
                                         
                                         
                                         
                                         
                                         
*Additional sheets should be attached if there are more Senior Executive Officers.

Correspondent bank
Please list main correspondent banks:
Correspondent Bank Name Location
https://www.nibl.com.np/index.php?
     
option=com_content&view=article&id=55&Itemid=60
           
           
           

© UnionPay International Co., Ltd. All Rights Reserved. 2017 Page 3 of 7

Section 2 - Anti-Money Laundering Procedures and Activities
1. Is your Institution required by national or federal law to comply with applicable AML legislation?
Yes No
If yes, please answer the following questions:
1) Please indicate the names of the applicable AML legislations:
Asset (Money) Laundering Prevention Act
2) Please indicate the name of regulatory authority that oversees AML compliance:
Financial Information Unit (FIU)
2. Has the regulator previously taken any action against the Applicant with respect to AML issues?
Yes No
If yes, please provide details including, if applicable, evidence that the action was closed:
     
3. Is your Institution chartered as required by local law?
Yes No
4. Is your Institution a financial institution?
Yes No
5. Is your Institution a shell bank?
Yes No
6. Is your Institution an offshore branch of your head office or operating under an offshore license?
Yes No
If yes, is it subject to your head office’s supervision?
Yes No
7. Does your Institution have a written policy, controls and procedures reasonably designed to prevent and detect money
laundering/terrorist financing activities in compliance with local legislation?
Yes (please provide detailed documents) No
8. Has your Institution’s AML Policy approved by the Board of Directors or Senior Committee?
Yes No
If yes, please specify the time when the Board or Senior Committee review the Policy last time:
June 2017
9. Has your Institution designated an officer to lead AML/CTF compliance work?
Yes No
If yes, is the officer designated and authorized by the Board or Senior Committee of the Applicant?
Yes No
10. Please list the following information of the AML officer:
ID Information
Full Name Title Nationality Date of Birth
Type Number Exp. Date
Chief
Ms. Bandana 27-July-
Compliance Nepalese Passport 06774649 23-Ocf-2023
Thapa 1962
Officer
                                         
                                         
                                         

*Additional sheets should be attached if there are more AML officers.

11. Is your Institution’s AML Policy applicable to subsidiaries and branches, both in the home country and in locations
outside of the home country?

© UnionPay International Co., Ltd. All Rights Reserved. 2017 Page 4 of 7

 Yes No Not Applicable
12. Does your Institution verify customer identities and conduct due diligence on businesses to ensure compliance with all
applicable laws and regulations (Know Your Customers, hereinafter referred to as KYC)?
Yes No
13. For your individual customers, which of the following information must be obtained as part of your KYC program:
Name Former name(s) used
Residence information Address
Date of birth Nationality
Telephone Fax
Identity document, type: Others, please specify: Employment details, expected
Citizenship/Passport copy transaction/income etc.
14. For your company customers, which of the following information must be obtained as part of your KYC program:
Background Shareholders/beneficial owners
Business scope Business performance
Location Contact information
Copy of business license and other related materials
Others, please specify:      
15. Does your Institution screen against applicable official sanction lists?
Yes No
If Yes, please answer the following questions:
1) Please specify all sanction list(s) and/or regulator(s): OFAC, HMT, UN, EU
2) Does your Institution update your list(s) within 48 hours after it is published by a competent authority?
Yes No
3) Does the screening technology logic allow the detection of reasonable name variations and is the logic periodically
reviewed?
Yes No
4) Does your Institution screen all relevant data fields (i.e., name, authorized signer, users)?
Yes No
5) Does your Institution screen all customers prior to establishing a relationship?
Yes No
6) Does your Institution screen against all entities that are owned 50% or more, in the aggregate, by or are controlled by
one or more individuals and entities appearing on a sanction list?
Yes No
7) Does your Institution screen existing customers within 5 business days after list(s) update?
Yes No
8) Does your Institution have any merchants or cardholders that appear on a sanction list or are located in a jurisdiction
subject to sanctions?
Yes No
9) Does your Institution reject/block/terminate/freeze the relationship and/or transaction with individual or entity that is a
positive match?
Yes No
10) Please include any additional information relevant to your sanction compliance program:
     
16. Does your Institution conduct risk assessment for all customers?
Yes No
If yes, will your Institution conduct enhanced due diligence for high-risk customer(s)?

© UnionPay International Co., Ltd. All Rights Reserved. 2017 Page 5 of 7

 Yes No
17. Does your Institution continuously conduct KYC, risk assessment, and (enhanced) due diligence for all customers?
Yes No
If yes, please specify how often: (e.g. once per year, etc.)
Atleast once every year for High Risk, Atleast once in 2 years for Medium risk, Atleast once in 3 years for Low Risk
customers.
18. Does your Institution use any system for monitoring suspicious activities/transactions/operations?
Yes No
19. Has your Institution implemented procedures to identify large cash transactions structured to avoid reporting
requirements?
Yes No
20. Does your Institution engage in reporting of suspicious activity?
Yes No
If yes, please list all regulators and agencies to which you report suspicious activity.
Financial Information Unit
21. Does your Institution track and record all AML issued raised?
Yes No
22. Has your Institution implemented periodic AML training programs for all staff?
Yes No
23. Does your Institution retain customer information and transaction records?
Yes Yes
If yes, for how long: atleast 5 years from transaction or closure of account.
24. Does your Institution engage any third party to handle card business?
Yes No
If yes, does your Institution ensure that third parties handling UnionPay International transactions on your behalf comply
with AML regulatory requirements?
Yes No
25. Does your Institution provide the correspondent accounts to shell banks?
Yes No
26. Does your Institution permit the opening of anonymous or numbered accounts (i.e. accounts where identification is not
reviewed prior to opening) by customers?
Yes No
27. Does your Institution allow third parties to directly or indirectly use your account(s) with any bank, (i.e. in the form of
“payable through” accounts)?
Yes No
If Yes, please answer the following questions:
1) Please indicate the names and addresses of these third parties:
     
2) Whether your Institution has formally identified these third parties?
     
3) How your Institution performs the ongoing monitoring of the activities of the third parties?
     
28. Please indicate when and who reviewed or audited your AML program.
Internal audit every year.

Section 3 - Signature

© UnionPay International Co., Ltd. All Rights Reserved. 2017 Page 6 of 7

I, on behalf of the Applicant, hereby make the representations and warranties that:
Any and all contents in this application form and other instruments submitted by the Applicant are authentic, accurate and
complete. Any consequences from inaccuracy or fraud herein shall be borne by the Applicant.
Full Registered Name of Applicant: Nepal Investment Bank Ltd.
Authorized signature (Principal Contact):

Date of signature and stamp: Signature and Stamp: signature

      (mm-dd-yyyy)
Stamp

Note: Principal Contact shall be the head of card center or equivalent, responsible for UnionPay Card Program and authorized to sign forms or documents
related to UnionPay Card Program on behalf of your organization.

     
Typed name and title of above

© UnionPay International Co., Ltd. All Rights Reserved. 2017 Page 7 of 7