AUTHORIZATION LETTER (Aby‡gv`bKiY cÎ)

Date (ZvwiL):

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

City Bank PLC. (wmwU e¨vsK পিএলপি)
Branch (kvLv): Account Title (wnmve/bvg):

Dear Sir/Madam (wcÖq g‡nv`q),

I/We hereby authorize Mr./Ms.

Address (wVKvbv) mobile no. (‡gvevBj bs) to collect

the item(s)/document(s) mentioned below on my/our behalf. (Avwg/Avgiv wb‡¤§ ewY©Z WKz‡g›U e¨vsK †_‡K msMÖn Kivi Rb¨
Rbve/Rbvev‡K Aby‡gv`b cÖ`vb KiwQ|)

 ATM/Debit Card (GwUGg/‡WweU KvW©)  Account Statement (A¨vKvD›U †÷U‡g›U)  Pay Order (‡c-AW©vi)

 FDR Advice (GdwWAvi GWfvBm)  DPS Certificate (wWwcGm mb`)  Cheque Book (‡PK eB)

 Balance Certificate (e¨v‡jÝ mvwU©wd‡KU)  Solvency Certificate (mj&‡fwÝ mvwU©wd‡KU)  Sanchaypatra (mÂqcÎ)

 Outward Returned Clearing Cheque (AvDUIqv©W wiUv©b wKqvwis †PK)

Cheque details (†PK weeib): __ __
 Other (specify) (Ab¨vb¨):

My/our authorized representative’s signature is duly attested by me/us below.

Avgvi/Avgv‡`i Aby‡gvw`Z cÖwZwbwai ¯^vÿi Avgvi/Avgv‡`i Øviv wb‡¤§ mZ¨vwqZ Kiv n‡jv|

Signature of the Authorized Person

Aby‡gvw`Z cÖwZwbwai ¯^vv¶i
Attested (mZ¨vwqZ)

Signature Signature
Signature of 1st Applicant Verified By Verified By 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)