Application for LankaBangla MasterCard
 
 
 About your application
 
I want to apply for a :
MasterCard Gold MasterCard Classic
(Minimum monthly income to apply is Tk. 10,000/- for a Classic Card and Tk. 40,000 for a Gold Card)
 
 About yourself
 
Mr. Mrs. Ms.
Your full name
(as in Passport/ID)		 :

First name

Middle name

Last name
Date of birth (dd/mm/yy) :
- -

 

        
Nationality :
Bangladeshi Non Bangladeshi
Passport No.
(if available)		 :  
Expiry date (dd/mm/yy) :
- -

 

        
If non-Bangladeshi  
Visa No. :  
Expiry date (dd/mm/yy) :
- -

 

        
TIN No. :
- -

 

        
Marital status :
Single Married
If married, is spouse employed? :
Yes No
No. of Dependants :
Father's name :
Mother's name : (a security feature of your protection)
Your name as you would like on the Card (Max. 21 characters including space)
 
 About your residence
 
Your residential status :
Owned Rented Company provided Other
If rented, rental per annum Tk. :
Residential address :
City :
Post code :
No. of years at current address :
Years Months
 
Your contact details (tel/fax/e-mail)
office phone :

Ext. No/Direct
Fax :
Mobile :
Residence phone :

Other
Email :
Your permanent address :
 
 About your work
 
Status :
Salaried Self employed Both Student
Retired Other (Please specify)

:

  
Company name :
Year of incorporation
(If self employed )		 :
Nature of business :
Designation :
Department :
Office address :
City :
Post code :
No. of years/months with current organization :
Name of previous organization :
Phone :
Total work experience :
Years Months
 
 About your income
 
If you are salaried

Basic (monthly)

Allowances (monthly)

Total monthly salary
Tk. Tk. Tk.
 
If you are self-employed :

Gross

Expenses

Net
Tk. Tk. Tk.
 
Additional income (if any, attach relevant documents)

  
Source of other income :
Income of spouse Tk. : Others Tk.
 

 Statement mailing address (select any one)
 
Your monthly statement will be sent in the form of:
Printed Statement (select anyone)
Office address
Residence address
 

 About your bank accounts
 
Bank name & Branch Account No. A/C Type Current balance
1.
2.
 

 Details of other Credit Cards
 
1.
Issuer :
Card number :
Credit limit (Tk.) :
 
2.
Issuer :
Card number :
Credit limit (Tk.) :
 
 References
 
Name of your relative or friend in Bangladesh :
His/her contact address :
Relationship with the person :
Phone :
Res :
Office :
Mobile :
 
 Supplementary Card application
 
Mr. Mrs. Ms.
Name of Supplementary Card applicant :

First name Middle name

Last name
Name of Supplementary Card applicant as you would like it to appear on card (Max. 21 characters including space)
 
Address :
Relationship with the primary Card applicant :
Spouse Parent Brother/Sister Child Other (Please specify) :
Date of birth (dd/mm/yy) :
- -

 

        
Occupation :
Mother's name
(a security feature of your protection)		 :
 
Would you like to set up a spending limit per billing cycle to your Supplementary Card?
Yes No
If yes, amount per month (Tk.) :

Or   

% of the Card limit
   
(lower of the two will be applicable and will be rounded off to the nearest'00
 

 Supplementary Card applicant declaration
 

I/we, the supplementary card applicant (s) agree, to be jointly and severally liable for all transactions processed by the use of the card (s) applied for and issued by the LankaBangla finance to the Primary Card applicant and/or myself (ourselves), and to be bound by all the terms and conditions of the LankaBangla Credit Card agreement which accompanies the card.
 

 Primary Card applicant declaration
 

I hereby apply for the issue of a LankaBangla Credit Card. I declare that the information provided in this application is true and correct and I shall advise you of any changes thereto. i herby authorize LankaBangla Finance to verify any information from whatever sources it may consider appropriate. I accept that LankaBangla Finance is entitled in its absolute discretion to accept or reject this application without assigning any reason whatsoever and that the application and its supporting documents shall become parts of LankaBangla records and shall not be returned to me. I acknowledge and agree that the use of the Primary Card and/or Supplementary Card(s), if any, issued on my account shall be deemed as an acceptance of the Terms and Conditions of the LankaBangla Credit Card agreement (which may be amended from time to time) accompanying the Card.

Upon approval I agree to pay the prevailing fees. By signing and/or activating and/or using the Card, I agree to pay all the outstanding balance on my Card be bound by the Terms and Conditions as mentioned in the LankaBangla Credit Card agreement. Where requested, I authorize LankaBangla Finance to issue Supplementary Card(s) for use on my account to the person(s) named who I undertake is /or over 18-years of age, and is a resident of Bangladesh and agree that you may provide information to him/her about the account. In case the Supplementary Card applicant is between 18 and 21 years of age, I hereby undertake that the use of such Card shall be made under my supervision and control. I also agree to get enrolled into CreditShield insurance program automatically upon opening of my Credit Card account with a 2 months free trial period and I understand that this insurance is not applicable to the consequences of a sickness or of an accident incurred prior to my enrollment in the policy. I hereby agree to indemnify LankaBangla against any loss, damage, liability or cost incurred by LankaBangla on account of any breach by me or the Supplementary Cardholder(s) of the aforesaid conditions or any other Terms and Conditions contained in the LankaBangla Credit Card Agreement or by reason of any legal disability or incapacity of the Supplementary Cardholder. I also understand that the Supplementary Card fees shall be billed in my statement and it shall be my primary responsibility to honor all charges incurred on the Supplementary Card. The continuation of the membership of the Supplementary Cardholder(s) shall be dependent on the continuation of my membership.

In consideration of LankaBangla agreeing to accept my request for sending my Credit Card monthly statement to my e-mail address in lieu of paper statement sent through courier service, I hereby agree that all statements whether through e-statement service or other means of transmission sent by LankaBangla for my Credit Card shall be accepted and upheld by me as correct and authenticate. I declare that I shall not raise any objection against LankaBangla on its agreeing the same and fully accept the risk and responsibility of statements transmitted by LankaBangla. LankaBangla does not warrant against any external factors affecting the privacy and/or security of e-mails during internet transmission. I also agree to keep LankaBangla indemnified against all actions, proceeding, liabilities and claims, cases, damages, cost and expenses in relation to or arising out of so accepting my request by LankaBangla and transmitting statements and information through e-mail. I assure LankaBangla that I shall inform it in writing of any change in my e-mail address or any request for discontinuation of this facility to Cards centre, LankaBangla Finance Limited, Safura Tower (Level 5), 20 Kamal Attartuk Avenue, Banani, Dhaka 1213. LankaBangla shall not be liable or responsible for data corruption, delay and/or interception of the information so given and reserves the right to update and vary such information from time to time and at any time.
 

 Card membership fee per annum (Primary/Supplementary)
 
MasterCard Gold : Tk. 2000 + VAT
MasterCard Classic : Tk. 1000 + VAT
 
For LankaBangla use only
Card No. :
     
Credit Limit (in Taka) :
Date (dd/mm/yy) :
- -

 

        
 
 Please Note
 
  • For prompt processing of your application, Please;
    :: Use CAPITAL LETTERS
    :: Tick boxes as appropriate and write NA where not applicable to you
    :: Countersign all changes or corrections you make
    :: Enclose the following documents
      a) Photograph (one copy)
      b) Copy of Passport (1st 6 pages)
      c) Personal Bank statement for last 6 months
      d) If salaried, latest original salary certificate/pay slip
      e) If self-employed, copy of Trade License and personal/company bank statement for the last 6 months
      f) Copy of TIN (Tax Identification Number) certificate
     
  • Complete all sections of the application form. Incomplete application may be delayed or cancelled
  • Primary Card applicant must be over 21 years of age. Supplementary Card applicants(s) must be at least 18 years of age.
  • For Non-Bangladeshi applicant(s), documentation requirement may vary.