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Account Services Form

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ACCOUNT SERVICES FORM

Branch Manager Date


Eastern Bank Limited Branch
Dear Sir,
Account No.

Account Title
Please arrange to:
Issue a duplicate statement of account for the period to
Issue a Bank Certificate / Balance Confirmation Certificate
Update my information as follows:
Present/ Mailing/ Permanent Address:
Phone:

Mobile: Email:

Please update the above Mobile No. and/or Email in the Debit Card(s) tagged with my/our above account.

Provide me with a copy of Cheque No. encashed through my

Account No.
Provide me the duplicate advice for the following entries :

Please cancel Standing Order for (Currency & Amount)

Due on (Date) Favoring

Any other request may be stated herein:

Customer Signature (All to sign if Join Signature Account) S. V. (full Signature)

BANK USE ONLY

Received By Date & Time

Charge Deducted Tk.

Action Taken By Authorized By

Delivered To Date & Time

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