Application for ATM Card

& other related Transactions

Date: a) Issuance of New Card

b) Lost/miscplaced Card
c) Damaged Card
The Manager, d) Forgotten Pin Code
Habib Bank Ltd., e) Blocking of ATM
Branch Name & Address: f) Activating after 3 unsuccesful attempts
g) Return of card captured at other ATM
h) Refund against Cash not delivered by ATM

Customer Account #:

Customer Name:

I would like to request for the transaction as marked below. You may kindly debit the above account to cover the bank’s charges
for the requested transaction.

Kindly issue me a New ATM Card & PIN Code for my above account.

Kindly issue me a New ATM Card & PIN Code for my above account as the card that was issued earlier has lost/misplaced.

Kindly issue me a New ATM Card & PIN Code for my above account as the card has been rendered useless due to damaged
magnetic stripe.

Kindly issue me a New ATM Card & PIN Code for my above account as I have forgotten PIN Code of existing card.

Kindly block my existing ATM card due to following reason:

Kindly activate my ATM Card No: as the same has been blocked after three
unsucessful attempts.

My ATM Card No: has been captured at (bank & branch)

ATM , on: upon receipt of the same , kindly inform me to collect the card from your branch.

Kindly arrange a refund to my above account of RO: being cash not dispensed by ATM against a
withdrawal transaction, while my account was debited for transaction amount. Details and location of the ATM is given below:

Date: Bank & Branch:

(I hereby confirm having received, reard, understood and agreed to be bound by the terms and conditions for the use of ATM Card)

Yours truly,

Customer Signature: Contact # (Mob):

Received ATM Card: Signature : Date :

Received PIN (in sealed envelope) : Signature : Date :

(Subject to Bank’s Terms & Conditions governing various transaction & accounts)