Application Form for Real Time Gross Settlement (RTGS) / National Electronic Funds Transfer (NEFT)

Branch

Date

Details of Applicant (Remitter)

Account Name

Account No

Mobile No

Purpose of Payment

Details of Beneficiary (Receiver)

Beneficiary Name

Account No

Bank & Branch

IFSC Code

Mobile No

PLEASE PROVIDE CORRECT BENEFICIARY A/C NO. AS THE CREDIT WILL BE EFFECTED SOLELY ON THE BENEFICIARY A/C NO. INFORMATION

Remittance Details

Amount to be remitted

Cheque No.

Bank Charges

Cheque Date

Total

Cheque Amount

Amount in Words

(Remit the amount as per above details by RTGS / NEFT, by debiting my / our Account for the amount of remittance plus bank charges. We agree to abide by the terms and conditions for the transfer.)

Acknowledgment

Beneficiary Name

Date & Time

Beneficiary A/c No

Amount Remitted

IFSC Code

Ref. No. / UTR No.