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RTGS / EFT Authorizatlon Form
Dgte: ...........
The Branch Manager
BIRAC Bank Lirnited
Branch
Debit Account's Information
Account Titte
Account Number
BRAC BANK
Type of Account
IWe hereby quthonze BlAC Bonk Lirrnited to Lebit ny (ou) ccourt ndcotey} tedrn sto edt te tourg crers ct through BEFIN/BD-RIGS f the transaction detal (egchi found gcceptoble by Bl Byr Lirrited
Amount (In Numbers) & Currency
Amount (ln words)
Date of Executlon
Credit Account's Information
Account Title
Account Number
Bank's Name
City
Routing Number/SWIFT Code
Reference/Purpose of Payment
Verlfied By:
Pin:
Accountholder's Signature
Signature & Date:
Ngme:
D Customer Physically Present in front of us at Service Outlet.
Ngrne:
AWC No:
City:
/We hereby confirm as per the EFT/RTGS Instruçtion, Receiving Bank shall have full rignts and title over the fund transmitted by way
of the BEFTN/BD-RTGS systern and We permit BRAC Bank Limited to intiote electronic credit entries for payment(s) to accaunts
maintained with other Banks. We also acknowledge that initiating bank shall have no legitimate controVliability over the fund once
transmitted. We also confrm thot the transaction willbe subject to BEFTN/BD-RTGS operoting ule as issued by Bangiodesh Bank.
BRAC BANK
Arnount:
Branch:
Time:
DD
lam completely aware of the RTGS transaction and I know that the RTGS payment is Fnal and lrrevocable in nature.
(RTGS Only).
Moble No:
MM YYYY
Debit
Moblle No
FOR BANK USE ONLY
Name:
Pin
Approved By:
Signature &Date:
Name:
AC No:
Amount:
EFT (BEFTN)
Trng 00 00AM/PM
*Custurrer Preerce o serice utes Mor¡ory
Bank Name:
Routing No:
Branch:
City:
Moblle No:
N EFT (BEFTN)
wwocoorKcom
BDT USD GBP EUR CAD JPY
Branch
RTGS (BD-RTGS)
Avaliabe Arnount:
ORTGS (BD-RTGS)
Credit
2nd Accountholder's Signature (it joint)
www.bracbank.com
Customer Copy