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Customer DEBIT CARD Request Form

This document is a request form for card-related services from Jamuna Bank Limited. It allows cardholders to request actions such as card replacement, reactivation, PIN reissue, and account linkage, while acknowledging awareness of associated fees. The form requires personal information and signatures for verification and processing by the bank's branch officials.

Uploaded by

Md. Saiful Islam Saif Nayabazar IB Br
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125 views1 page

Customer DEBIT CARD Request Form

This document is a request form for card-related services from Jamuna Bank Limited. It allows cardholders to request actions such as card replacement, reactivation, PIN reissue, and account linkage, while acknowledging awareness of associated fees. The form requires personal information and signatures for verification and processing by the bank's branch officials.

Uploaded by

Md. Saiful Islam Saif Nayabazar IB Br
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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To, Date:……………

The Head of Card Cardholder’s Request Form


Jamuna Bank Limited
Card Division
Head Office: Dhaka

Through: The Manager, ……………………….Branch.

Dear Sir,
I do hereby request for the following thing(s) [(tick(s) is/are placed in the appropriate Box (es)]:

 Issuance of replacement Card  Lost/Stolen/card close


 Incorrect Name/Spelling mistaken on Card
 Wrong Photograph on Card
 Cards is physically damaged
 Magnetic strip error
 Others (pls. specify)………………………………………
………………………………………………….…………
 Reactivation of Blocked Card  Incorrect PIN entered at ATM or POS Terminal
 Blocked over phone
 Others (pls. specify)……………………..………………..
……………………………………...……………………...
 Reissue of PIN  Lost/Stolen
 Forgotten
 Others (pls. specify)………………………………………
………………………………………….…………………
 Linkage of Account Number: 1) , 2)

Moreover, I declare that I am aware of the fees & charges as mentioned overleaf for the aforesaid request(s) made by me
against my JBL Q-cash, VISA Debit Card/VISA Credit Card, My full Name, Account Number & Card Number are below:

Name :

Account Number :

Card Number :

*Printed Name :

*Fill in this Box if your name is Incorrectly Printed on the card. Cardholder’s Signature
For Branch’s use Only:

 Cardholder’s signature is verified &


Recommended for taking necessary action. Signature of the Branch official with PA
Number & Branch Seal.
For CD use Only:

 Action is taken as per customers request Signature of the Authorized Officer

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