Credit Card Services Form – 1 (Endorsement, Limit & Payment Rearrange, E-Commerce, Enhancement, Priority Pass)

Date D D / M M / Y Y Y Y
Cardmember’s Name: Mobile Number:
Amex
Visa
Others:
Authorize & Agree Cardmember’s Signature and Date
I have authorized the below instructions. I agree to the relevant
Terms, Conditions and Clauses mentioned in this form. I also agree to
pay the relevant fees & charges.
A. Endorsement
Product Endorsement Please specify Year(s) / If Till Expiry of Passport
Amex Amount: USD ________________ Year(s): Till Expiry of Passport
Other Amex:_______________ Amount: USD ________________ Year(s): Till Expiry of Passport
Visa Amount: USD ________________ Year(s): Till Expiry of Passport
Passport No.: _______________________ Passport Expiry Date: _______________________
Foreign Part Status Open Block
Declaration: I assume full responsibility for complying with the provisions of the Foreign Exchange Regulation Act 1947, and rules, orders and
directives issued there under. I declare that the foreign exchange released to me shall be used for expenses incurred by me in a foreign
country. I understand this card can be used for Internet transactions in compliance with Bangladesh Bank regulations as effective and amended
from time to time. I accept that The City Bank is entitled to accept or reject this application without assigning any reason.
B. Limit Rearrange or Transfer / Payment Transfer
Limit Rearrange BDT ________________ to USD part USD _______________ to BDT part
BDT ___________ of Amex / Visa / Others: USD ___________ of Amex / Others:
Limit Transfer TO TO
BDT/USD part of Amex / Visa / Others: BDT/USD part of Amex / Visa / Others:
BDT ___________ of Amex / Visa / Others: USD ___________ of Amex / Others:
Payment Transfer TO TO
BDT/USD part of Amex / Visa / Others: BDT/USD part of Amex / Visa / Others:
C. E-Commerce Enable Request Yes No
Transaction Purpose: Website address / URL:
Transaction Amount: USD _______________ No. of transaction attempt / attempts: _____________
Note: 15% VAT will be applicable for any online payment made to international merchants located outside the geographical boundary of
Bangladesh for services such as royalty, various other internet services, advertisement on Facebook, YouTube, Google etc. as directed by
National Board of Revenue (NBR) & Bangladesh Bank. City Bank won’t take the responsibility of any fraud or illegal transactions through
internet.
D. Priority Pass Issuance / Re-Issuance
Primary Amex Platinum Card Member Primary Amex Gold Card Member
New Issue
Supplementary Amex Platinum Card Member (Please Specify):
Reissue and Reason Lost Damage Captured Other (Please Specify):
Declaration: I have made the required TQ limit of USD 200 available by endorsement.

E. Limit Enhancement / Decrease

Auto Limit Enhancement Yes Note:
Limit Enhancement CIB Fee, BDT 150 + 15% VAT will be applicable
From __________________ To __________________ for approved enhancement request
Limit Decrease
Mandatory Documents for All
Copy of National ID / MRP Passport / Driving License / Birth Certificate E-TIN CIB & Undertaking
For Salaried Person
Salary certificate/ Last 3 months Pay-slip Last 6 month salary reflecting authorized copy bank statement
For Business Person (Sole Proprietorship)
Latest Trade license copy Last 1 year business reflecting authorized copy bank statement
Enclosure: For Business Person (Private Ltd. Company/Partnership Business)
Form X & XII of Memorandum of Association (MOA) Partnership deed
Last 1 year business reflecting authorized copy bank statement
For Secured Card: New Security / Security Replacement / Same Matured Security
Security Advice Slip Bank Charge Document Adhesive Stamp
Last 6 months Bank Statement (only for card against DPS)
For Bank Use Only
Received and Verified by Staff:
Client ID:
(Sign, Seal and Date)
 Annex-N
CIB ONLINE INQUIRY FORM-1
Individual’s (Borrower/Co-borrower/Guarantor/Owner) Information

Name of the Bank/FI: The City Bank Limited

FI Code: 0044 Branch Code: .......
* Type of Financing: .............. * Total Requested Amount/ Credit Limit:
Instalment Contract data:
Number of Instalment:
Instalment Amount:
Periodicity of Payment (please tick): Monthly/Quarterly/Half Yearly
Role in the Institution: Chairman/ MD/ Sponsor Director/ Elected Director/ Nominated Director (by Gov)
Nominated Director (by pvt. Inst)/ Shareholder/ Partner/ Owner of Proprietorship/ Others
(If the individual is an owner/director/partner of any company then select a role)
Individual Subject data:
Title: ....................... *Name: ...............................................................................................
Father’s Title: ............. *Father’s Name: ..................................................................................
Mother’s Title: ........... *Mother’s name: ..................................................................................
Spouse’s Title: ........... Spouse’s Name: ..................................................................................
NID Number:

ETIN:

*Date of Birth: *Gender (Pls tick): Male/ Female

*District of Birth: .................. *Country of Birth: .........................

*Permanent Address:
*District: ................. *Street Name and Number: .................................................................
Postal code: ............ *Country: ..........................
Other ID:
ID Type: Passport / Driving License / Birth Registration
ID Number: ................................ ID Issue Date: / / ID Issue country: ............
*Sector Type (Pls tick): Public/ Private *Sector Code:
Telephone Number:

Date: / / Signature of the Customer

Seal and Signature of Authorize officer Seal and Signature of the Manager

‘*’ indicates Mandatory field

 Annex-K
UNDERTAKING
Attachment - Ka
To
The Manager
……………….………………………………………
…………..…..………………………………………
…………..…..………………………………………

Subject: Provision of information on the ownership of companies and their bank liabilities.

Dear Sir,

I, …………………………………………………. owner/partner/director/guarantor of …………………………………………………., am applying for

sanctioning/renewal/rescheduling of a loan in my own name/aforementioned company's name. My father's name:
……………….………………………………………., mother's name: …………………………………………………………...……, husband's name (in case of
married woman): ………………………………....……………………, Permanent address: Street No/Village ……………………..........…………...…… Street
name/PS/Upazila …….………………………………………………… District ............................................ postal code ...............................................
country ....................................................., Business/Office address: Street No/Village ………………………………...…… Street
name/PS/Upazila ……………………………………………………… District............................................ postal code ...............................................
country ....................................................., Date of birth: ....................................................., District of birth:
....................................................., Country of birth: ....................................................., National ID Number:
....................................................., Other ID documents (Passport/Driving license/Birth Registration Certificate) ID Number:
....................................................., ID issue date: ....................................................., ID issue country:
....................................................., TIN: ....................................................., Gender: Male/Female, Telephone Number:
..................................................... are given for your kind consideration. The list table:

Serial Name of the Main Address Additional Address Whether the company is availing any loan or
no. Company not
Yes No
Name of the Name of the
bank/FI branch
1.

3.

4.

Apart from the stated above, if any liability in my own name or my company's name is found, I will be bound to obey any decision
made by the authority concerned relating to sanctioning/renewal/rescheduling of the loan applied for and I will be punishable by
law for providing this false or fabricated information.

Seal and signature of the bank official Customer's Signature:

who certified the borrower Name:
Name of the Borrowing Organization:

*If necessary, extra paper could be used for list of companies.

 Requirements for Auto Limit Enhancement

Required Documents

1. Credit Limit Enhancement request form

2. CIB form
3. Undertaking form
4. NID & E-TIN copy.