Date :................................................

The Manager
Card Centre
Nepal Investment Bank Limited
Putalisadak, Kathmandu

Subject: Authority to process credit card transaction through Fax.

Dear Sir,

I hereby authorize following merchant to process transactions as detailed below.

Merchant Name : TIRUPATI HOLIDAYS TOURS & TRAVELS P. LTD.

Merchant No :012000179

Merchant Address :Kamaladi, Kathmandu , Nepal

Card Holder Details.

Cardholder Name :....................................................................................................................................

Card Number :............................................................................................................................................

Expiry Date :.................................................................................................................................................

CVV Number :..............................................................................................................................................
(3 digit printed number in the signature panel of card)

Transaction Amount :.................................................................................................................................. USD/INR./NRS.

Passport Number :......................................................................................................................................

Billing Address :...........................................................................................................................................

Contact Address :........................................................................................................................................

Phone No :....................................................................................................................................................

Fax No :..........................................................................................................................................................

Email ID :.......................................................................................................................................................

Disclaimer:
I kindly request you to process above-mentioned transaction. I hereby agree and accept that I have fully read and agreed the terms and conditions for the purchase of goods/ services through this transaction and I hereby indemnify merchant and Nepal Investment Bank Limited for any disputes arising by virtue of this transaction. The card has been issued in my name and I am the authorized user.

Note: Copy of Passport, Copy of front and backside of card should be enclosed here with.

Sincerely,

...............................................................................

Signature