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PUBALI BANK LIMITED
CARD DIVISION
HEAD OFFICE, 26 DILKUSHA C/A, DHAKA.

T'he Dir-ision Ilead

Carcl l)n.ision
I Ieacl Oftice. [)l'rtlia

CLAIM AGAINST ATM CASH WITHDRAWL

l)ear Sir.
()Lrl customer pertirlmccl .\'fNI Cash u.irl-rdran,1 transactior-r but recluisitc cash rvas not rccier.ecl clr-re to:\'I'\l
(,rsh Itctract ()r son.rc techr-rrcal reasolr. It is rl-rerefi.,rc rerlucstecl to check \'our records and arrange to rcfr-rnd
the custonrer fol untler mentionecl transactiofl(s).

Card Number Br. Code & Amount )ate & Time Acquirer Bank &
Customer A/l ^'Lgcation r

03Yo * ab[12 l2oz3

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SPeciS, nature of complaint:

No Cash Received: Partial Cash Recierr.d, I-l

Itcmarks/I)ctarls (1f an1, )

Customer Contact Number b\L)6\ b Email Id:

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Customer Srgnarure & Date Branch r\uthorized Signature & Date

FOR CARD DIVISION USE:

(,lurnr I {or.rolccl: }lciiurcl thc custonrer C)u.n .-\'I'N{ NPSB,\T\I

(-lrrinr l)eclincd; .\'1 1\l Log atrachecl \laster(lard.\'f\l \r1s.\ .\'fNf

l)roccssed bt' Ar-rtl-rorized b1- Date