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APPLICATION CUM REQUEST FORM OF NATIONAL ELECTRONIC FUND TRANSFER FOR REBATE OF CENTRAL EXCISE DUTY

I/We hereby submit the following bank details for NEFT of payments / Sum due to us.

Full Name of the Claimant (as appearing in the bank records Contact No. Name of the Bank Telephone No.of Bank IFSC Code Account No.(Only 15 digit) MICR ( Only 9 digits) Please confirm that your bank is listed with RBI for NECS

I/We are full aware of the procedure involved in NEFT and I/We shall notyour office responsible for incorrect information provided by us or failed / delayed transaction . In case of sanction of my /our claim in full /part,non-receipt of funds in my /our bank account shall be brought to your notice within a period of one month from the sanction of such claim. I/We undertake to refund voluntarily excess amount (if any) received me/us.

Date :- 30.05.12 Place :- Mumbai .

For Authorised Signatory

Duly Bank attested 2 Copies + cancelled cheque

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