ELECTRONIC PAYMENT REQUEST FORMAT (NEFT/RTGS)

(TO BE FILLED IN CAPITAL LETTERS)

All Fields are Mandatory

EIP VENDOR CODE (Refer the PO to

know your vendor code)

Name of the Organization & ________________________________________________

Complete postal address with ________________________________________________
PIN Code & E-mail id. ________________________________________________
________________________________________________

Contact No: STD Code

Phone No

Type of Organization Proprietary Partnership Firm

Public Limited Private Limited Others

If, it is a Partnership Firm, please ensure that all the Partners sign in this Format.

Bank Name: _____________________________________ Pan No:________________________________

Full Bank A/C No:

(Should not have any prefix or suffix with alphabets, words, hyphen, bar, coma or full stop.)

Type of Account Current Cash Credit Others

Please tick in the box Specify

Bank Branch Code:

(Nine digits MICR code
Appearing next to cheque no.) (Please attach a copy of cancelled or blank cheque)

Bank Address: _______________________________________________

(Complete postal address) ______________________________________________

Pin:

If your Bank’s branch is having Electronic payment facility (NEFT & RTGS), please interact with
your banker and furnish IFS Code in the box given below. This is the easiest, reliable & fastest
mode of payment and the fund will be directly credited to your account. (RTGS takes 2-3 hours,
NEFT same day)

IFS Code (Eleven digits)

We hereby accept to receive our payment through Electronic Fund Transfer system. We shall intimate
to you immediately in case of any change in the above particulars.
(Name & Signature by Authorised Signatory with Seal)

Place:
Date:
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Please contact us at myeft@lntecc.com for any further clarifications.
Courier the Original filled EFT format & cancelled Cheque to below mentioned address.
Larsen & Toubro Limited, SSC Accounts Payable,ECC Division,HQ Accounts,
Mount Poonamallee Road,Manapakam,Chennai-600089. Ph : 044-22526818