INTERNAL

Bank Zambia
NAME: _________________
A/C NO: ________________
TEL NO.________________
ADDRESS: ______________

The Card Centre Manager

GSSC Nairobi

Dear Sir/ Madam,

RE: UNBLOCKING OF FUNDS -VISA ELECTRON TRANSACTION

DEBIT CARD NUMBER ________________________TRANSACTION DATE________________

ACOUNT NUMBER______________________

TRANSACTION AMOUNT__________________ MERCHANT______________________________

I hereby agree to indemnify you and keep you indemnified from and against all losses, costs, charges,
expenses, actions, proceeding claims and demands whatsoever which may arise by reason of your having
released the block on my account.
Should the merchant avail sufficient proof to the contrary, you are authorized to recover the same from
my account.

Reason for Unblocking funds

Yours faithfully,

Witnessed by (bank official): ___________

Signature ____________________

FOR OFFICIAL USE ONLY

Customer verified by

1st Authorized Signatory_________________

2nd Authorized signatory_____________________

Note approval should be within Signatories delegated authority for transaction type.
Ensure you append a branch date stamp.