Cheque Requisition Slip

PF-06 The Head of Branch/Manager Gulshan ..........Branch Sub: Requistion for Issuing Cheque Book against my/our CD/SB/STD Account No. Account Title :. Bengal IRIS TAKUMI LTD. Address : Safura Tower (10th Floor Southern Side), .................................................................. .................................................................. .................................................................. Phone No: .................................................................. Yours faithfully Date : ................................. Signature of A/C holder Signature of A/C holder(s) To be filled up by the Bank authority Cheque Book Issue Register Entry No. Folio No. Date Signature verified by Authorised Signature Acknowledged receipt P.A. No. (if any).......... Dear Sir : With reference to my/our above account maintained with your Branch, I/we request you to please issue me/us a Cheque Book containing.... 100 ....leaves. Above account number and address of the account holder(s) have been tallied. Cheque book containing.............leaves bearing number...........................to................................. be issued and entered against the account in the Computer. Received the above SB/CD Cheque Book contained.............leaves, counted and found in order Marking of Computer Posting Date 20 Kemal Ataturk Avenue, Banani C/A, Dhaka-1213, Bangladesh. '+81-3-3863-1421 100 ✓ ✓ Mr. Masataka Irie Mr. Kogoro Osumi