DHL Worldwide Express (BD) pvt Ltd

Head Office: Molly Capita Centre (Level 4 5)

76 Bir Uttam Mir Showket Road
Gulshan-1, Dhaka-1212

Advance and Refund Request Form

Date: DD-MMM-YYYY
A. Customer Information:

Name of the Customer RAINA TARANNUM

Address BALUR MATH, NARAYANGANJ NARAYANGANJ, 1400 BD Post code-1400, BD
Name of Contact Person RAINA TARANNUM
Contact Number 8801841192667 Email Address shakilmahmud9671@gmail.com

B. Advance Related Information:

Reason for Advance Duty Advance Other (Please specify): ....................................................................................................

HAWB Number 4323919390 Mode of Payment

Money Receipt/ payment
Details of Advance Payment Date DD-MMM-YYYY
reference No.
Advance Amount (BDT) Remarks (if any)

C. Information for Refund (if any):

Mode of Refund (please tick mark) (1) Required information

Account Name
Account Number

Electronic Fund Transfer/Bank Transfer Bank Name

Bank Branch

Rounting Number

bKash (non-Agent/ individual customer only) bKash Number

(1) If mode of refund is not selected and corresponding required information is not provided, refund process may potentially be delayed.

Details for Refund (2)

Invoice Number Invoice Amount Refund Amount (BDT)
(2)
Not required, if all other information of this form is accurately filled in and provided to DHL at the time of making advance payment

I, consignee of above mentioned AWB, have paid the mentioned advance amount estimated by DHL based on declared content and value of shipment.
In case of duty advance, if the duty amount determined by customs is higher than the advance paid herewith, I will pay the additional amount. I also
opted for the refund mode of excess payment (if any).

(3)
Consignee's Signature
(3)
Signature not required if form is sent via email

Important Note:
a) DHL processes advance refund (if any) three times in a month -10th, 20th and 29th based on the receipt of this Form fully and
accurately completed by customer. DHL reserves the right to change refund frequency.
b) Subject to receiving by DHL fully and accurately completed form at the time of receiving advance money, refund is generally
processed on -
10th: for duty invoices dated between 25th of last month & 5th of current month,
20th: for completed form received between 6th & 15th of current month, and
29th - for completed form received between 16th & 24th of current month.
c) If any of refund processing dates is a non-work day, refund will be processed on next work day. Receipt of the refund to customer
bank account may vary based on customer's banking service provider.