website: www.bb.org.

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cÖwZôv‡bi Rb¨ Avw_©K cÖ‡Yv`bv wn‡m‡e mnR k‡Z© FY/wewb‡qvM myweav cÖ`vb cÖm‡½|

b‡fj K‡ivbv fvBivm (COVID-19) Gi `ªæZ we¯Ívi I msμgY cÖwZ‡iv‡a wek¦Ry‡o bwRiwenxb jKWvDb I †hvMv‡hvM ¯’weiZv
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02| Avw_©K cÖ‡Yv`bv Znwej n‡Z FY/wewb‡qvM MÖnY/cÖ`v‡bi cÖwμqv wb‡¤œ D‡jøL Kiv n‡jv :
(K) Avw_©K cÖ‡Yv`bv Znwej Ges Gi D‡Ïk¨t ißvwb evwY‡R¨i Ici b‡fj K‡ivbv fvBivm (COVID-19) Gi †bwZevPK
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c„ôv - 1/6
(N) Avw_©K cÖ‡Yv`bv Znwej n‡Z FY/wewb‡qv‡Mi cwigvY I weZiY cÖwμqvt Av‡jvP¨ Znwej n‡Z ‡KejgvÎ kÖwgK-Kg©Pvix‡`i
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(P) Avw_©K cÖ‡Yv`bv Znwej n‡Z e¨vsK KZ©„K M„nxZ FY/wewb‡qv‡Mi mgqKvj I cwi‡kva c×wZ: Qq gv‡mi †MÖm wcÖwiqWmn
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c„ôv - 2/6
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 c„ôv - 3/6

Form-A
(Letter head of schedued bank)

Ref: Date:

General Manager
Accounts and Budgeting Department
Bangladesh Bank
Head Office
Dhaka.

Dear Sir,
Application for loans/Investment from Financial Stimulus Fund

In accordance with the procedure set out in BRPD Circular No. ….. , dated …………………….,
we hereby apply for the loans/Investments from Bangladesh Bank against the advances made/to be
extended by us under the following details:

Sl. Name of eligible Address Salary for 3 Average Amount Remarks

No. borrowers months monthly applied for
(Dec’19, salary in one month
Jan’20 and Taka estimated
Feb’20 salary
1 2 3 4 5 6 6

We confirm that the borrowers are eligible for financing under Financial Stimulus Fund as per
terms and conditions stipulated in the aforesaid circular and hold ourselves liable for any falsity or
misstatement.

We would, therefore, request you to grant the loans/Investments and credit Tk ……… (in words)
to our current account maintained with your Motijheel Office. We also hereby authorize you to debit our
current account with you in realization of principal upon expiry of the permissible period for instalment
payments of the loans/Investments, if not repaid earlier by us.

Yours faithfully,

Signature........................ Signature........................
Name:…………………. Name:………………….
Designation:...…………. Designation:...………….
PA No………....……….. PA No………....………..
 c„ôv - 4/6

Form-B
PROMISSORY NOTE
(to be on letter head pad)

Principal Amount: Tk............. (With reference to the Sanction Letter, Ref. ................. dated .................) Interest
Rate: 0.00%

Date of Note: ..............

PROMISE TO PAY: As per BRPD Circular No. ….., dated …… 2020 …............ (Name of bank) promises to pay
to BANGLADESH BANK, or order, in lawful money of the People’s Republic of Bangladesh, the principal amount
of Tk......... in figure (Taka......... in words)as monthy installment on expire of grace period of six months from the
date of disbursement, until paid in full within eighteen months.

PAYMENT: (Name of bank)... will pay the principal amount of loans on monthly installment basis unless
otherwise extended. (Name of bank).... will pay Accounts and Budgeting Department at Bangladesh Bank head
office or at such other place as Accounts and Budgeting Department/Bangladesh Bank may designate in writing.

PRIOR TO SIGNING THIS PROMISSORY NOTE, ...(Name of bank) READ AND UNDERSTOOD ALL THE
PROVISIONS OF THIS PROMISSORY NOTE. (Name of bank)...... AGREES TO THE TERMS OF THE
PROMISSORY NOTE AND ACKNOWLEDGES RECEIPT OF A COMPLETED COPY OF THE
PROMISSORY NOTE.

Name of the borrower: ..........................

Name of bank
Signature

Authorized Signatory(ies)
Title(s)
Signature

Witness(es) Name: Name:

Designation: Designation:

Date Signed .............. ..............

c„ôv - 5/6
 Form-C
Name of bank:
Address:

Statement showing repayment and outstanding against loans from Financial Stimulus Fund

Sl. Name of the Address Date of Date of Disbursed Outstanding Service Instalme Date of Balance Overdue
No. borrowers disbursing disburseme amount in amount in charges nt recovery in Tk as Amount
loans nt by Tk Tk as realized by amount of … as on ----
Bangladesh of…… bank in Tk in Tk
Bank

1 2 3 4 5 6 7 8 9 10 11 =(7-9) 12

Signature:........................................................................
Name:..............................................................................
Designation.....................................................................
PA No...........................................................................
Date:................................................................................

c„ôv - 6/6