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{Form#CD20}

Card Division, Shimanto Square (5th Floor), 80 Pilkhana, Road 02,


APPLICATION FORM FOR
Dhanmondi R / A, Dhaka 1205
Contact:8802-9650830, 01701215206-7 Ext 160-167
FUND TRANSFER
Hot Line: 01711287222, 01713048666, Fax: 880 -2-9650820 ( ft.card@nationalbankbd.com )
Web: www.nblbd.com | Email:ft.card@nationalbankbd.com

Date: Card No. :


D D M M Y Y Y Y

Amount: Taka (In word): ………………………………………………………………………………………….………Only.

Branch Name: ………………………………………………………………………………………… Branch Code:

For Account Credit Only 


Account Name: …………………………………………………………………………………………
Account No. :

For Pay Order Only 


Beneficiary Name: …………………………………………………………………………………………………………………………………………………………………

Bank Name: .…………..……………………………………………………………… Branch Name: ……………………………………………………………………


Routing No.: .…………..……………………………………………………………… A/C No. : ……………………………………………………………………………
A/C Name: ……………………………………………………………………………………………………………………………………………………………………….…

 I, hereby declare that the information provided above are correct and I belong to the mentioned NBL Credit Card.
 I, hereby authorize Card Division, National Bank Limited to Debit my NBL Card with charges and vat as applicable
and Credit to the account mentioned above as well.
 I agree that the request submitted after the cut off time will be executed in next batch or next working day as applicable.
 I, hereby agree and understand that the procedure for crediting the account is subject to the regulation and guidelines
of National Bank Limited and Bangladesh Bank..
 I, further acknowledge that National Bank limited will admit no liability for any consequences arising out of erroneous
details provided by me.

Cardholder’s Name: ……………………………………………………………………………


Mobile No. : ……………………………………………………………………………
Name:

PA No.
___________________________________
(Verified by) Signature & Seal
[Signature on the Fund Transfer Application Form must be the same as Credit Card opening form.]
Cardholder’s Signature

Verified & Approved By | Transaction ID:

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