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Central Bank of India

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APPLICATION for Funds Transfer Under RTGS/NEFT
Date· .................................
The Branch Manager
Central Bank oflndia
Bio· ......................................... .
Respected Sir,
Please remit a sum of Rs ......................................... (Rupees .......................................................................................................only) as per details
given below and debit the amount with your charges to my/ our account with you.

Details of Applicant Details of Beneficiary

1. City .......................................................................................... .
1. N ame ........................................................................................... .
2. Bank........................................................................................... .
2. Account N o . ................................................................................
3. Branch ...................................................................................... .
3. Type of Account : HSS /CD/ CC / OD
4. Customer ID No ......................................................................... 4. Account N o . ..............................................................................

5. Address ....................................................................................... 5. Type of Account : HSS /CD/ CC/ OD

··········..···....................................................................................... ....................................................................................................
6. Tel./ Mob. N o . ............................................................................ 6. N ame ........................................................................................ .
7. Emajl ID/ Fax N o .................................................................... .. 7. Tel./ Mob. N o .......................................................................... .
8. PAN N o ...................................................................................... . 8. Customer ID N o. (if any) ...........................- .......................... ..

9. ...................................................................................................... 9. IFSC Code .................................................---················

We agree to abide by the Real Time Gross Settlement System (RTGS) Guidelines/ Regulation / Rules etc. issued by Reserve Bank of India,
from time to time, and also the guidelines and or Terms and Conditions of Central Bank oflndia, from time to time.
Under normal circumstances, the beneficiary Banlc / Branch would credit the beneficiary's account on the same date (i.e. on the date of this
application) at the beneficiary Banlc Branch centre subject to the terms and Conditions mentioned overleaf and also subject to the RTGS
guidelines/rules/regulation of RBI.
Yours faithfully
Applicant's Signature(s) verified by
Applicant's Signature (s)
························································
For Bank Use Only Date: .. ..... ......... ... ............. .
S.S. No. Officer: HSS/CD/CC/OD Deptt.
The lncharge of RTGS
1. Amount debited for F/t'Rs ..... ..... ..... .. ..... .... .
2. Banlc Charges Rs ........... .. ........................... . Transaction entered as per details of Transaction Authorised & Funds
3. Total Rs ................ ......... .................... ... ...... . Beneficiary given above. Remitted through RTGS as per details
of Beneficiary given above.
4. Account No .... ....... .... ...... HSS/CD/CC/OD
Priority Code .. ........ ................. ....... ... . RTGSSr. No .. ..... ........... ..... .... .. ... .. .... .
S. Debit Rs .............................. ...................... .
(ifany) MF No . ......... .. ........... .. .. .. .. .. .. .... ...... .. .
Officer IFSCCode ... .. ...... .. ..... ............... ..... ... .
HSS/CD/CC/OD Deptt. Authorised officer
Authorised officer
S.S. No. S.S. No.
S.S. No.
(MAKER)
Date: Time: (MAKER)
Date : Time: Date : Time :

Acknowledgment
Received application form from (Name ... .. .... ... ...... .. ...... ... .. ...... ............ ..... .. .. ... .. ... .... .A/c no. (HSS/CD/CC/OD) ....... ... .... ...... .. ... .. ... ..... ... ..
For Rs . ... ......... ......... .... .... ... ....... ........ on(Date) ... ...... ... ......... .... .. ... .at(Time) ... ... ... ........ ........ .... . For funds transfer under RTGS / NEFTas
detailed below.
Beneficiary Name ... ... ... ....... ...... .... .. ....... .... .. ...... ....... ... ... City .... .. .. ... ........ .... .......... . Bank .... ........ ... ...... ... ..... ... Branch ... ..... ..... ..... ..... .. .... .
Account No .. ... ................ .... ...... ..... ...... ... .. .... ..... ... .. Type ofA/c: HSS/CD/CC/0D
Signature of Ofticcr
Seal