Branch: ATM CARD APPLICATION a [ff COLELLO Type of Account: L_Jraiiuat {_Tscte Proprietorship [Thor Reena [J news card O Supplementary ATM Card L] jeplacernent ATM Card eM e ke ene fecourt|_| l l seoveL| | TTT TTI IT} DONTE LITT TTT TT EVEL TWecon name meee ola Tetephone: MP eee 1 we apply fran ATH Card faci frm Albarka islamic Bark and ares to abe by all pplcable terms and condllens ax stated oer (hichhave en resd and understood) and ar amended / determined by Albaraa ilarie Bank orn time tit. 1 Vw contr chat thelevormationsubentted abaveis true and compte ta thebestof myfour knowiedge and understanding. 1 Vweauthorse the bank to Bebecharge my/our accourtwith any arnount withdrawoy mafus from ts desigated ATM machineslong wath ‘ay charges applicable thereon without refarence ta mes. 1 se apply tars roplacement Car das to oatthaf/4amage/Pnfaratten and see holéthe bank harass fr any enim of the lst / ‘stolen damaged ATM Card. Original ATM Card No. Signature of the Accountholder(s) eee eae e live confirm receiving my / our ATM Card & Pin code as per above detall, ‘Authorised Signature (5) Data Received 1 Data Received: Application checked: _J¥es |_|No ‘Application Checked:|_|Yes |_|No Signature (s) Verified: _|¥es _|No Card Issued i_|y¥es [_|No Hold Mail Status + ]¥es “To Boiry : Daily Withdrawl Limit PIN Sent to +) ete Date Data Sent to Card Centre: cardSentto scrote ‘Approved by ‘Approved by