Client Name:

Client Email:

Client Code:

Contact No.:

Amount:

Special Request (if any):

I/We intend to withdraw the above stated amount of Taka from my/our portfolio account maintained with you. Therefore, I/We would appreciate if you please issue cheque(s) for the above amount at the earliest.
I/We also do hereby declare that no purchase will be made against the amount requested for withdrawal as well as the proportionate loan amount.