The General Secretary. Nepal Mountaineering Association. PO Box 1435, Kathmandu, Nepal.

1. Name of the Peak ........................ Height ................
2. Period for which permit is desired ..............................
3. Trekking Route ......................................................
4. Climbing Route ......................................................
5. Name, Nationality & Address of the Leader of the team
Full Name ................................................................
Nationality ...............................................................
Passport No. ............................................................
Home Address ..........................................................
Kathmandu Address ...................................................
6. Name, Nationality & Passport No of other team members
Name ...................... Nationality ............... PP No .......
Name ...................... Nationality ............... PP No .......
(A list may be attached)
7. Appointed representative in Kathmandu
............................................................................
8. Name & Organization or address of Sirdar / Guide to be employed:
Name ................................. Book No. ......................
Address .................................................................
Organization ...........................................................
9. Fee: climbing permit fee of US $ ............. is attached
Number of persons: ..................................................
Dear Sir,
I understand the rules of the Nepal Mountaineering Association and agree to comply with the rules. Nepal Mountaineering Association will not be responsible for any loss of life, accident or damage to the team members during the course of the expedition. I have the necessary trekking permit issued by the Immigration Department for this trip.
Date .................. Signed ................................................
The Leader of the Climbing Group