MADINA MARKET BRANCH

DATE: 23.11.2017 Account NO: 1) 150.200.12833

Branch Manager, Account title:

Dhaka Bank Ltd,
Hobigonj Branch. Saira Akther Hena

COLLECTION AUTHORISATION

Dear Sir,
I hereby authorize Mrs. Hamida Begum to collect the items indicated below on my behalf:

 ATM/Debit Card  Chequebook  Pay Order

 FD Receipt  DPS Certificate  Account Statement

 ATM/Debit Card Pin  Solvency Certificate  Sanchaypatra

 Other (Specify)
.

This collection authorization shall remain in force until I revoke it by written notice. My authorized
representative’s signature is duly attested by me as below:

Signature of Authorized Person

Accountholder’s Signature

FOR BANK USE ONLY Customer ID:

 Signature verified

Received By Action Taken by