GENERAL REQUESTS (wewea Av‡e`b)

Date (ZvwiL):

Branch Manager (kvLv e¨e¯’vcK) Account Number (wnmve bv¤^vi):

The City Bank Ltd. (w` wmwU e¨vsK wjwg‡UW)
Branch (kvLv): ___________________ Account Title (wnmv‡ei bvg): ______________________________________

Dear Sir/Madam (wcÖq g‡nv`q),

Kindly issue statement/certificate/document(s) as indicated below (webxZ wb‡e`b GB †h, Avgvi/Avgv‡`i GKvšZ cÖ‡qvR‡b
wb‡¤§ewY©Z weeiYx/mb`/WKz‡g›U Bmy¨ Kivi Rb¨ Aby‡iva KiwQ|):

 Account Statement (duplicate) wnmve weeiYx (cÖwZwjwc): From ___/___/_____ to ____/____/_____

 Balance Certificate (e¨v‡jÝ mb`): Address To (eivei)____________________________________________
 Copy of the Cheque No (‡P‡Ki Kwc, hvnvi bs)._________________________________________________
 Solvency Certificate (mj&f¨vÝx mb`)
 Annexure "B" Certificate (G‡b·vi ÕweÕ mb`)
 Foreign Currency Encashment Certificate (‰e‡`wkK gy`vª bM`vqb mb`)
 Interest Income Certificate (B›Uv‡i÷ BbKvg mb`)
 Fixed Deposit Encashment Certificate (GdwW wnmve bM`vqb mb`)
 Inward Remittance Certificate (BbIqvW© †iwgU¨vÝ mb`)-Amount(f)--------Currency (gy`ªv )--------Date of
Credit___/___/_____
 Tax Certificate for the purpose of (U¨v· mb`-Kvib ¨খ KiyY)___________________________________
 Others (Ab¨vb¨)________________________________________________________________________
I/we hereby authorize the Bank to debit all applicable charges from my/our above mentioned account.
(Dc‡i ewY©Z Avgvi/Avgv‡`i G¨vKvD›U †_‡K e¨vsK KZ©„K avh©¨K…Z mKj PvR© †WweU/ KZ©b Kivi Rb¨ e¨vsK KZ©„c¶‡K Aby‡gv`b w`w”Q|)

Please deliver the requested item/s to_______________________________________________whose signature

is attested below. (Avwg/Avgiv Dc‡iewY©Z weeiYx/mb`/WKz‡g›U e¨vsK †_‡K msMÖn Kivi Rb¨ Avgv‡`i Aby‡gvw`Z cÖw Zwbwa†K Aby‡gv`b cÖ`vb
KiwQ Ges Zvnvi ¯^vv¶i Avgvi/Avgv‡`i Øviv wb‡¤§ mZ¨vqb Kiv n‡jv|)

____________________________
Signature of the Authorized Person
Aby‡gvw`Z cÖwZwbwai ¯^vv¶i

______________________ ________________________
Signature of 1st Applicant Signature of Joint Applicant
(cª_g Av‡e`bKvixi ¯^vv¶i) (hyM¥ Av‡e`bKvixi ¯^vv¶i)
FOR BANK USE ONLY CUSTOMER ID: C B

CHECK POINTS
We the undersigned confirm that all the related document(s) are in order as per CBL Ops Manual/SOP/related circulars and all
necessary approval(s) are taken.

Initiated By CS Official/CFP Recommended by BOM/Designated Approved by BM/Designated

(with seal & sign) Official (with seal & sign) Official (with seal & sign)