Agrani Bank Limited
................................................................Branch
Application Form for RTGS
Date:………………………….
Dear Sir,
I/we under signed request you to transfer the fund as per the details given bellow and debit my followng
account:
SENDER / ORIGINATOR INFORMATION:
Name: ………………………………………………………………………………………………………………..
T24 A/C. No: ………………………………………………………………………………………………………………..
Amount BDT: ………………………………………………………………………………………………………………
In Word:
……………………………………………………………………………………………………………….
RECEIVER / BENIFICIARY INFORMATION:
Name : ………………………………………………………………………………………………………………..
A/C. No: …………………………………………………………………………………………..
Bank Name: …………………………………………………………………………………………..
Branch Name: ………………………………………… BR. Mobile no :……………………………….
Routing no: …………………………... ……..(Optional )
Thana: ……………………………………. District :…………………………………………………
I/We do hereby declare that the information given above is true and accurate and I/we agree comply with
terms & conditions of Bank's RTGS Service
Sincerely Yours,
…………………….. …………………………….. (Signature of Account holder as per SS card)
Originator/Applicant Name: …...............................................................................................................
Mobile No: ……………………………………………………………………………………………………………….
Address: ……………………………………………………………………………………………………………..
………………………………………………………………………………………………………………………
For Bank Use Only (Approved By)
……………………………………… …………………………………………
(Manager's Signature with Seal ) RTGS Officer's Signature with Seal
