From: BRS GROUP - [email protected]
Reply-to: [email protected]
Tel. No.: +22968479406
Reply-to: [email protected]
Tel. No.: +22968479406
Banque R�gionale de Solidarit�
B�nin (BRS-B�nin)
Adresse :144 Avenue Van
Vollen Howen Cotonou
Tel : +229 68479406
E-mail : [email protected]
APPLICATION FORM FOR ATM VISA DEBIT CARD
Dear Sir/Madam,
You are advised to fill this application form and return it back to us as to enable us proceed your ATM VISA CARD.Being desirous of availing the facility of using ATM Visa Debit card, I/We furnish the information below.
(1.)Your Full Name:��������
(2.) Date of Birth:���������..
(3.) Nationality:����������.
(4.) A/C. No:�����������..
(a/c. card will be issued to proprietor/proprietress only.)
(5.) Your Address:���������.
(6.) Tel. No:������������.
(7.) Cell No:��������.. Email ID:��������.
We hereby declare to abide by the rules/terms & conditions as applicable to Banque R�gionale de Solidarit� International Visa Debit Card holder. You are to follow the stipulated guidelines for usage of Banque R�gionale de Solidarit� Debit Card and comply with the existing as also the modifications.
YOURS IN SERVICE
MRS MARY ATUGOH
ATM DEPT (BRS)
CC CENTRAL BANK OF BENIN
CC: FOREIGN REMITTANCE DEPARTMENT
CC: FEDERAL MINISTRY OF FINANCE
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