DD / MC Application Form r.

L: HDFC BANK
( Application form to be accompany cheque only. In case of Issuance We understand your world
against Cash, MC / DD / NEFT the amount would not exceed Rs.49,999/- )
Branch :- - - - - - - -
Date: -----,-------
Please Issue (Tick aa Applicable)
0 Demand Draft payable at - - - - - - -
0 Managers Cheque

~ - -- - - - - - -- - - - - - - - - - - - - : -_ _ _ _ _ _ _ _ _ (In words)

----------------
-~----------- ------
Mode of Payment :- Cash / Cheque No.

Purchaser Name:
PI ease deliver the Demand Draft/ Managers Cheque to Mr I Ms. ____________ Whose signature

is appended below
Customers signature
(Purchaser)
Bearers-Signature

I acknowledge Receipt of the OD / MC as requested

Customers Name
(Purchaser)
Signature of Recipient
I / We enclose Cheque no. _______ drawn on my /our above account in favour of " HDFC Bank Ltd for DD/MC.
I / We Authorize you to Debit my / our above account towards issuance of the above DD / MC through Cheque .
I / We further authorize you to debtt the aforesaid account for the service charges I tax. as applicable.
I / We acknowledge that in case I / we have issued single cheque / instruction for debit to my/ our account for issuing
more than one Demand Draft / Managers Cheque. then the same will effect as multiple debit entries in my / our account
DD/ MC against cash will be issued below Rs so,0001' to Non- customer< and should be accompanied

with KVC documents ·

Mandatory UCIC and Banned Oedupe Verified for DD/ MC
against cash. Tick only If applicable
For bank Use onl'l
Authorized by (Emp code and sign)
Processed by (Emp code and sign)

Ref No
ni:iv <>nrl r.h~,..k~~ hv
DD I MC I UTR No
Charaes Recovered Rs tanolicable onlv for Non Customer):
nd
Transaction Authorized bv (2 Leven <for amount> 5 lacs).
KYC documentation done by (only for Non-HDFC Bank