Form # RTGS (V-3)
Branch Name Application
Date: D D M M Y Y Y Y
I (we) hereby authorize Bank Asia Limited, hereinafter called the Bank, to initiate credit entries and if necessary debit
correction and adjustment entries to/from my/our account and financial institution listed below.
Sender/ Originator Information
Account Title
Account Number
Mobile Number Email No:
Purpose of Transfer
Currency Amount
Amount to be Transferred Amount in words:
Receiver/ Beneficiary Information
Account Title
Rec. Account Number
Bank Name
Branch Name
Routing Number
I/We authorize Bank Asia Limited to generate Real Time Gross Settlement (RTGS) transaction as mentioned above giving
consent to charge my account as per Bank Asia standard schedule of charges and VAT (if applicable). I am/we are fully
aware that these transactions will be posted to the bank account mentioned in this form. I/We confirm having read and
agreed to the terms and conditions stated in the overleaf.
Confirm Rec. AC number
For Customer Use For Bank Use Only
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Account Holder(s) Signature/Originator Verified by Approved by HoB/MoB
Signature
Customer Copy: Bank Asia Limited……………………………….Branch
Sender/ Originator Information Receiver/ Beneficiary Information
Account Name Account Name
Account Number Account No
Amount Bank Name
Amount in Word Branch Name
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A/C Holder/Originator Signature Verified By Approved By
:: Terms & Conditions ::
1. RTGS Transaction is irrevocable and final. The RTGS Payment Instruction/Authorization form to be filled by the
customer carefully i.e. Receivers A/C, Title/Name, Receiver Bank & Branch, Amount etc.. Originator/Customer
should re-check all the information’s before final submission to effect payment. Authority shall remain in full force and
effect until Bank Asia Ltd has received written notification from the customer of termination of transfer/payment in such a
time and manner as to afford Bank Asia Ltd a reasonable time to act upon it.
2. In case of any failure/delay of transaction due to any system failure i.e. Electricity/Connectivity/Bangladesh Bank Link
problem etc. or any instruction(s) by BB/ PSO (Payment Service Operator) as originating/responding bank, Bank Asia will
not be liable for such non execution of transaction. However, Bank may execute such transaction while system is in order
winthin the day.
3. If transaction is not processed due to regulatory bindings/act of God/Political unrest etc. (any regulatory authorities or
PSP (Payment Service Provider) Bank will not be liable for such failure to execute transaction(s).
4. If due date of execution falls on a weekend or in holiday, the transaction shall be made on the following business date.
5. Bank is authorized to deduct RTGS transfer charges and VAT from Originators account (s) also preserves rights of
reversal entry / set back the amount in case of any wrong posting or adjusting required, i.e. excess /short claim,
transaction failure etc.. Adjustment will be made as required from the said account or any of his account without prior
notice to Originator.
6. In the event while an Entry is rejected by the RTGS System, it shall be the responsibility of the Originating Customer to
remake such entries. Bank Asia shall have no responsibility to re-initiate any returned entries until Customer remakes
such entries in accordance with the RTGS Rules. However, Bank may initiate the entry if otherwise not cancelled by the
customer.
7. Bank Asia shall have sole discretion/ right to reject any Entry that does not fully comply with the requirements of this
agreement, including but not limited to the requirement to maintain an adequate account balance or line of credit.
8. Bank Asia will not be liable for any failure or delay of transmission if such transmission would result customer(s) having
exceeded any limitation upon its intra-day net fund transfer declared in TP/KYC at his/her AOF in pursuant to
Bangladesh Bank Guidelines, violate any risk control provision promulgated by the Bangladesh bank or of any
Bangladesh Governmental regulatory authority.
9. For Trade payments, additional information like Invoice number/reference number(s) needed to the receiver by the
Receiving bank for future reference or keeping record.
10. It’s important to provide the accurate information to the senders bank i.e. Receiver Name, Receiving Bank and Branch
Name with Exact Routing Number, Receiving Customers A/C, Reference (If applied) etc. Bank Asia will not be liable for
any failure of such transfer(s) due to lack of essential information(s) or wrongly provided information(s).
11. As per BD-RTGS system rules mismatch or differ in Receiver Name and A/C, Receiver Bank may rely on A/C number only.
I do hereby agree with the above mentioned terms and conditions and declare that, my /Our A/C is registered for RTGS
transfer and Transaction Profile and KYC is updated or completed.
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Signature of Customer (s)
:: Terms & Conditions ::
1. I/We hereby agree that aforesaid Beneficiary details are correct. I/We further acknowledge that Bank Asia Limited
will accept no liability for any consequences arising out of erroneous details provided by me/us.
2. Bank Asia will not be liable for any failure of such transfer(s) due to lack of essential information or wrongly
provided information.
3. As per BD-RTGS system rules mismatch or differ in Receiver Name and A/C, Receiver Bank may rely on A/C
number only.
4. I/We understand RTGS request is subject to Bangladesh Bank regulations and guidelines governing the same.
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Signature of Customer (s)
