CUSTOMER REQUEST FORM THROUGH AGENT OUTLET CUSTOMER REQUEST FORM THROUGH AGENT OUTLET

Date: Date:

The Manager The Manager

Dutch-Bangla Bank Limited Dutch-Bangla Bank Limited
_____________________ Branch, __________________ _____________________ Branch, __________________

Subject: Letter of requisition for Agent Banking Cheque Book. Subject: Letter of requisition for Agent Banking Cheque Book.

Dear Sir, Dear Sir,

This is to bring your kind attention that I have been maintaining an
account in your prestigious bank. I would require a cheque book against
my Agent banking A/C No: ___________________________ A/C Name:
______________________________. Please issue 20 leaves of cheque
book against the account.
This is to bring your kind attention that I have been maintaining an
account in your prestigious bank. I would require a cheque book against
my Agent banking A/C No: ___________________________ A/C Name:
______________________________. Please issue 20 leaves of cheque
book against the account.

I want to collect the cheque book from _________________branch. I want to collect the cheque book from _________________branch.

Thaking You Thaking You

Signature of the A/C holder Signature of the A/C holder

Name : Name :

Mobile : Mobile :
Authorized signature with seal of Agent Outlet Authorized signature with seal of Agent Outlet
Outlet A/C No.: Outlet A/C No.:

If cheque book is not collected within 03 (Three) months from the If cheque book is not collected within 03 (Three) months from the
date of issue, it will be destroyed at your risk & responsibility. date of issue, it will be destroyed at your risk & responsibility.