RTGS/ NEFT APPLICATION FORM

(Application form to accompany with a chque)

Branch Panadri , Sitarganj -262405
Date
Remitter Details
Account No. 5 0 7 0 1 0 2 0 0 0 0 0 5 0 5
Name of Applicant A L P L A I N D I A P V T L T D
Remitter Addres: S I T A R G A N J
Contact No:(M) 7 5 0 0 8 0 3 3 0 0
E Mail ID: P O O J A . S A H @ A L P L A . C O M

Beneficiary Details
Name :
Bank Name:
Account Number: Reconfirm Account No. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Bank's IFSC Code:
Mobile No: Landline No.
Amount (In figures):
Amount (In Words):
Payment Details
Enclosed is Cheque No ------------------ drawn on my/ our account for Rs.--------------------- favouring Axis Bank Ltd. Towards tha above RTGS/ NEFT transaction. OR
Kindly debit my above account no Yes No I/ We have read the conditions overleaf and agree to be bound by them.

__________________________ __________________________ __________________________

Authorized Signatores

Tran. ID No.______________________ Entered Verified

RTGS/ NEFT APPLICATION FORM

(Application form to accompany with a chque)
Branch Panadri , Sitarganj -262405

Date

Remitter Details
Account No. 5 0 7 0 1 0 2 0 0 0 0 0 5 0 5

Name of Applicant A L P L A I N D I A P V T L T D

Remitter Addres: S I T A R G A N J

Contact No:(M) 7 5 0 0 8 0 3 3 0 0

E Mail ID: P O O J A . S A H @ A L P L A . C O M

Beneficiary Details
Name :

Bank Name:

Account Number: Reconfirm Account No. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Bank's IFSC Code:

Mobile No: Landline No.

Amount (In figures):

Amount (In Words):

Payment Details
Enclosed is Cheque No ------------------ drawn on my/ our account for Rs.--------------------- favouring Axis Bank Ltd. Towards tha above RTGS/ NEFT transaction. OR
Kindly debit my above account no Yes No I/ We have read the conditions overleaf and agree to be bound by them.
__________________________ __________________________ __________________________
Authorized Signatores

Tran. ID No.______________________ Entered Verified