Mercantile Bank PLC.

Agent Outlet Application

Name *

Father's Name*

Mother's Name*

Date of Birth *

Gender *

Male Female Others

Mobile Number *

NID Number *

Present Address*

Permanent Address

73BSXN

Loan Payable (Per Month)	: 8,561 BDT
Total Interest Payable	: 2,729 BDT
Total Payment (Principal + Interest)	: 102,729 BDT