i Mercantile Bank Limited efficiency is our strength Date: tot Application Form DLocal Debit Card Clobal Debit Card Branch Name & Code: Ciprepaid Card (General/Student/Hajj) (01.CD/SB/SND A/C No with MBL (mandatory for debit card) Photo 02. Full Name: (03. Name on Card: {sto be printed on Card (eaves spaces reach word, maximum 19 characters] (04, National ID No. 05, Date of Birth: 06, Passport No ee IssueDates Expiry Date: sot 07. Marital Status: [JMarried []Unmarried D)single 08.Sex: C]Male LiFemale Clother 09. Father's Name/Spouse Name: 10. Mother's Name: 11.Contact Address: Mobile: Email: 12.0ccupation: 3. Monthly Income:| 14. Source of Income: 15.Nominee for Prepaid Card: Name: NID No: Date of Birth: ‘Mobile No: Relationship fee) 16.Marketed by: Name Employee ID No: equired Documents for Global Debit Card/Prepaid Card Copy of National ID/Birth Certificate copy of Passport copy of Utility Bill & Bank Statement, any photograph of Applicant Signature of Applicant Signature verified by MoP/HoB P.ANo: lient 1D: Card No, Remarks: ‘Authorized Signature Authorized Signature16. 1. is 2. a1 » ae a eee eet ‘Terms & Conditions for the Visa Local Debit Card/Prepaid Card/Global Debit Card Operations of MBL: Only account holders of Mercantile Bank Limited can apply for Visa Debit Card or Prepaid Card applicants may not maintsin any depos account with Mercantile Bank Limited but related papers are required 28) Bank meas Mercantile Bank Limited and ts successors and assigns. 1b) *Visa acquirers’ mean any bank or financial iasttution whichis ceased by Vi desertion. ©) Card means valid MBL. Visa debit ard issued a cardholder t aval services andor to purchase andor to raw Cash faites by properly presenting the same atthe Bank or oder Visa authorized acquirers; ATM or POS. 1) Cardholder’ means the Applicant mentioned in his Application Frm, to show and for whose uses the Card has been sued thse equest 8) Customer’ means the Cardholder sited above 1) “Account means an account maintained bythe Bank inthe name of the Cardolder fp) “Aareement” mean the “Terms & Condition” along wih the MBI. Vita local Debit Cad/Prepaid Card\Gobal Debit Card Applicaton Frm, 2) Al eansactions init by the Car, weather elestoncally or otherwise wil be debited from the designated acount, 1b) The Bank sal debt the designated account for the amount wothdavn from any ofthe Visa bit Automated Teller Machine (ATM) or POS transactions fr goods ‘nd services obtane from Visa authorized merchants n Bangladesh by the use ofthe Card, The Bank's records generated electronically o there, shall be deere to be conclusive proof af the careeines ofthe transactions notwithstanding the fst hat there exists no debit voucher sighed by the catdholdee to support transactions through the ATM or POS. «) Ifthe designated account becomes overdrawn by the use ofthe Card, the Cardholder shal be charged wi intrest at such rata the Bank determines ands the fees snd expenses as determined by the Bank. Any such overdawing is repayable on demand 4) In consideration of issuing the Card, the cardholder undertakes tinder the Bank against losses, claims, actions, proceedings, demands, damages, costs and expenses ncured or ssined by te Bank of whatever nature and howsoever ssing out of orn connection wih the issuance or Use ofthe Card, provided any that Bank acs in good faith ©) The Bank shall hae the right to charge the Customer any fes fr issuance and us of the Card on peso basis ‘The Bank reserves the right to imi the tal cash withdrawal or goods and serves purchased at Visa authorized merchants by the Cardholder ding # 24-hour period ‘The Card shal a all ines, emains the property of the Bank and the Bark may in is wnfetered discretion and without giving any reason to withdraw the Card or the services thereby offered or any part of such services al any time without any prior notice whereby the Cardholder wil be esposible for turing the Card per request fom the Bak ‘he Caré and PIN ae issued to the Caruhoer ently at the Cardholder's risk and the Bank shall bear no lisility whatsoever for any loss or damage or expense whasooveransing whether dirty or indrely asa result of any transaction made withthe Card and shall be indemnified by the Cardholder, agains any su oss or damage ‘The Cardholder shall ot disclose the PIN to anyone. The Cardholder wil be isle othe bank for any and all ansactions made by the use ofthe Cad and rch agrees to indemnify the Bank foray iss or damage however eased by any unauthorized use of Card or PIN, Unles the Bark has received notice in writing of any ss, damage or the fof the Card or disclosure ofthe IN prio to any unauthorized use ofthe Card or PIN fr this purpose use ofthe Card by a person who obiined possession ofthe Cad withthe consent ofthe Cardholder consttates authorized wee ofthe Card "he Bank shal debit the designated account forall related charges wit respect to the Card and the use thereof and the charges as may be anounced from me ote by the Bank or otter Visa atborized aquite asthe ease maybe, incu charges foe any'replacement ofthe Cad ‘The Bank reserves the ight o refuse an application ofthe tsuance of Card and to withdraw a anytime and at ts sole discretion alright and privileges pertaining to the Card. The Bank shall not be responsible for ay loss or damage or expense whatsoever and howsoever arising wheter dirty or indtely as a result of any ‘malfunction af the Catd or any ofthe Visa ATMS, the insulicency of funds in such machine or oterwise "he Bank doesnot warrant and wll not be responsible forthe Card not being honored for any reason whatsoever. In the event of replacement ofthe Cad due o whatever reasons as requested bythe Aecount holder, the Bank wil levy a charge st bythe Bank Management In the event of resetting PIN, she Bank wl levy a charge St by the Bank's management (Card olde wil ot use this cr for any egal tansacton or amyhingunlawtl, under te laws of Bangladesh ‘he Casal cease o be vad andthe Bank shall he ented othe immediate return of he Cardin he oven of 2) Closure of the designated account 1) Death ofthe Cardholder ©) The cardholder’ authority to operate he designated account if teminated, 4) The Cardholder ceases tobe a customer of the Bank, ©) The Bank request for its return All atifcations andor question eonceming the use ofthe Catd shoud be directed tothe Branch Manages ofthe Catdholde’'s ranch afte MBL Catd Division ‘All rules and regulation governing the operations of curteat and savings accouns will be appliabl ofthe Card transactions eating o such accounts ‘The Bank may at any ime change Terms and Conditions witout prio notice othe Cardholder These Terms and Conditions wl stand amended if such amendment are necessitated by aw, goverment eguations o istustions issued bythe Bangladesh Bank Fees and charges will be determined periodically by the Bank of othe Visa auerized aequier Cardholder may terminate tis Agreement by serving 60 days prior notice ote Bank before its ex In case of any aa of ature, wa, its, civil distubance, changes of law over whieh the Bank has no contol and when ay such cases result ina impossibility fr the Bank to peefonm this Agecment, the Bank may terminate this Agreement before its expiry without assigning any reasons whatsoever. All disputes are subject the ursition of counts n Bangladesh only iterational to conclude agreements with merchants to accept Visa cards of all | do hereby acknowledge tha Ihave ead and uaderstood the above terms and conitons and agree to comply with them ‘Signature of he Applicant with date