EBL Cards Division

Sabera Tower (3rd Floor)

House # 42, Road # 52, Gulshan North C/A
Gulshan 2, Dhaka - 1212
NAME

: ________________________________________________

CARD NUMBER

MOBILE NUMBER

: ________________________________________________

Please tick the online transaction type and mention the amount of USD you
need to use for the transaction:
Membership fee of Foreign Professional and Scientific Institutions/ Fees for
Application, Registration, Admission, Examination in connection with admission into
foreign educational institutions (please attach relevant documents).
USD Amount Required: _________________
Hotel booking
USD Amount Required: _________________
Purchase of Goods or Intangibles (Software/E-Book/Other)
USD Amount Required: _________________
(Transaction amount limited to $100)

Therefore, I request EBL to enable the online transaction facility of my card with effect
from ________________ to ________________.

I am aware of the transaction and data risks involved with internet usage of Card and
will be completely liable if any dispute occurs on my card pursuant to this usage. I am
also aware that unless reported lost or stolen to EBL, all transactions made with the Card
will be solely Cardholders responsibility.

Cardholder Signature & Date

Note: Please email your filled out form with relevant documents to cardsteam@ebl-bd.com with a copy to
contact_center@ebl-bd.com. You can also submit the form to any EBL branch.