*r AB Bank $

Pleasefiii upthisfarrntr:applyforSimplyPaylnstaliment
sr*ryPuy Gffivrsa
mostercqrd

SchemeandsendittoCardDivision, ABBankLimited,BC|CBhaban,30-31 Dilkusha

CiA, Dhal(a 1000, Bangiadesh.

Cardmember's l\anre

Cardmember's Ccnt. No

Card Number X X X
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Transacticn Date o
U
Purchase Amount BDT (Bangladeshi Takai
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co
lVlerchant i\ame co

SirnplyPay Tenor 3 6 9 12 18 months (Please tick as appr"opriate)

would like to enroll in AB Bbank SimplyPay lnstallment Scherne. I have read, understooci and agreed with all the terms ancj cor.rdiiisns
Yes, i
(as mentioned helow) of SimplyPay lnstallment Scheme.

lVlerchant Seal & Signature Card member's 5ignatirre

ABBfS use only

Tracking No Authorized Signature Authorized Signaturr: