1. Name of the Peak ..................................    Height....................... .
2. Period for which permit is desired: .............................................. .
3. Trekking Route : ........................................................................ .
4. Climbing Route : ........................................................................ .

5. Name, Nationality and address of the Leader of the team:

       Full Name : .......................................... .
       Nationality: .......................................... .
       Passport No : ....................................... .
       Home address: .................................... .
       Local Address in Kathmandu: ................................... .

6. Name, Nationality and passport No. of other members in the team :
      Name : ....................................................... Nationality ........................... P.P. No .................... .
      Name : ....................................................... Nationality ........................... P.P. No .................... .
      Name : ....................................................... Nationality ........................... P.P. No .................... .
      Name : ....................................................... Nationality ........................... P.P. No .................... .
      Name : ....................................................... Nationality ........................... P.P. No .................... .

7. Appointed Representative in Kathmandu : ......................

8. Name and organization or address of Sirder/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 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 : ............................         Signature of Group leader, .......................................