CARD DIVISION, CHQ

Online Transaction Authorization Form

Card Holder Name :

Card Number :

Mobile No : + 8 8

Passport No : Expiry Date:

(Please put a tick where applicable):

 Membership fee of Foreign Professional and Scientific Institutions/ Fees for Application, Registration, Admission and
Examination in connection with admission into foreign educational institutions (please attach relevant Documents).
 Hotel booking
 Purchase of Goods or Intangibles (Legitimate purchase of items of goods and services such as downloadable application,
software, e-books, Magazine/Newspaper subscription fee etc. from reputed and reliable sources single Transaction will not
be more than US $300.)

PARTICULARS
Beneficiary name of the transaction:
Purpose of the Transaction:
E-commerce/ Beneficiary website address:

Website URL address (product/service’s specific address):

Required Amount ( BDT)

Required Amount ( USD)
(Please make sure your Endorsement enlisted)
Possible Transaction Date: ( DD:MM:YYYY) From: To:
Possible Transaction Time: ( HH:MM:SS) From: To:

I am aware of the transaction and data risks involved with internet usage of Card and will be completely liable if any dispute
occurs on my card pursuant to this usage. I am also aware that unless reported lost or stolen to ONE Bank Ltd, all transactions
made with the Card will be solely my responsibility.

Furthermore, I understand that the use and subsequent settlement of the International Credit Card will be guided by the
Guidelines for Foreign Exchange Transactions.

Yours Faithfully,

Card Holder Signature & Date

For Bank Use Only

Documentation Checked: Date: D D M M Y Y Y Y
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CMS Execution: Date: D D M M Y Y Y Y

M

Head 2/F HRC Bhaban 46 Kawran Card Card Center, Corporate HQ Fax +88-02-956957 24 Hour
Quarter Bazar C.A. Dhaka-1215, Center Zaman Court (5thFloor) E-mail cards@onebank.com.bd OBL Cards 16269
Bangladesh 45 Dilkusha C/A, Dhaka -1000 Website www.onebank.com.bd Helpline