NATIONAL ELECTRONIC FUNDS TRANSFER APPLICATION FORM

To
The IPP Cell
PRE-PRINTED ADDRESS OF IPP CELL NECESSARY
_________________________________
_________________________________

Sub : Option for NEFT

Sir,

I am interested to receive my annuity amount through NEFT.

My details are as follows.

(1) Policy Nos ___________________________________________________

___________________________________________________

(2) Name & Address of Annuitant : ____________________________________

_________________________________________________________________

_________________________________________________________________

(3) Annuitant’s Bank Name : ________________________________________

(4) Annuitant’s Bank Address : _______________________________________

(5) Annuitant’s Account Type : Savings/Current/Cash Credit/NRI _____________

(6) Annuitant’s Account No. __________________________________________

(7) Annuitant’s Branch IFS Code : _____________________________________

(8) Contact Mobile / Landline No. ______________________________________

(9) E-Mail Id : _____________________________________________________

(10) Do you want to receive SMS/E-mail alert on

payment of annuity to your A/c : Yes / No ____________

Kindly transfer the amount payable to me under the aforestated policies as per
details stated above.
I have enclosed the following document to this effect. (Please √ appropriate item)

A. Cancelled cheque leaf

B. Photo copy of the page of Bank cheque/pass book containing details

_____________________
Signature of the Annuitant Date :