2 PAYORDER FORMS

Dutch-Bangla Bank Limited

Branch
Pay Order Application Form
Date
Kindly issue me/us Pay Order as under in lieu of (ticked below):
Cash for Tk. tendered herewith
Cheque No. dated for Tk. tendered herewith
Debiting my/our A/C No. with you for Tk.
Received Instrument (s) Name of the Applicant
Full Address

Credit

Signature of Applicant

A/C. No. ...................................

PAY ORDER NO. IN FAVOUR OF AMOUNT

Total

Amount (in words) Taka

Cash Officer Authorized Officer Authorized Officer

GBF -23

Dutch-Bangla Bank Limited

Branch
Pay Order Application Form
Date
Kindly issue me/us Pay Order as under in lieu of (ticked below):
Cash for Tk. tendered herewith
Cheque No. dated for Tk. tendered herewith
Debiting my/our A/C No. with you for Tk.
Received Instrument (s) Name of the Applicant
Full Address

Credit

Signature of Applicant

A/C. No. ...................................

PAY ORDER NO. IN FAVOUR OF AMOUNT

Total

Amount (in words) Taka

Cash Officer Authorized Officer Authorized Officer

GBF -23