Date: ____/ ____/_____

The VP & Head of Cards Operation

DutchBangla Bank Limited
Cards Operation Division, Head Office
315/B,(2nd Floor) Shahid Tajuddin Ahmed Saroni
Tejgaon I/A, Dhaka-1208

Dear Sir,

I do hereby request you to kindly allow internet facility in my DBBL Visa Gold
Local/Multicurrency/Classic Local/ Multicurrency Credit Card. The details are as follows:

Name : ...............................................................................................

Card No.
:

Amount : USD (In word)

Amount : BDT (TK In word )

Date : from______/______/____________ to ______/______/____________

Time : from to

Reason : _________________________________________________________________

I also confirm that I will be liable/responsible for all the transactions made by my aforesaid credit
card in the said period and duly make payment for all the dues.

____________________
(Cardholders signature)

For Card Divisions use only:

Cardholders signature verified by: ____________________________

(Signature with date)

Internet facility parameter activated by: ____________________________

(Signature with date)

Internet facility parameter blocked by: ____________________________

(Signature with date)

[P.S.: Please contact to DBBL Cards Operation Division at 9830096 or e-mail to

cards@dbbl.com.bd for using of internet activate and deactivate respectively.