RTGS/NEFT Application Form Date: A. Details of Applicant A.

Details of Applicant

RTGS/NEFT Application Form Date:

1. Name of Account ` 2. Account No.

B. Details of Beneficiary

1. Name of Account 2. Account No.

B. Details of Beneficiary

1. Name of Account 2. Account No. 3. Bank Name: 4. Branch 5. IFSC Code 6. Amount to be Remited Rs. Add Bank Charge Rs. Total Rs. Rupees

1. Name of Account 2. Account No. 3. Bank Name: 4. Branch 5. IFSC Code 6. Amount to be Remited Rs. Add Bank Charge Rs. Total Rs. Rupees

For Bank's Use Only

For Bank's Use Only

Debited Appicant's A/c Total Rs. Date: Remittance No.

Debited Appicant's A/c Total Rs. Date: Remittance No.

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

Conditions : Remitting banks shall not be liable for any loss of damages arising of reciting from delay in transmission or delivery therefore in dephering the message from any cause whatsoever or from the misinterpretation received action of destination bank or any act beyond our control

Bank's Authorised Signatory

Bank's Authorised Signatory

Applicant's Signature