DD /MC Application Form HDFC BANK

(Application forn to be accompany chegue onlv. In case of issuance Wo unclorstand your world
against Cash, MC /DD/NEFT the amount would not exceed Rs,49,999/- )
Date
lh-ll- 2022 Branch:
MansaxoJaz calany
Please Issue (Tick as Applicable) manholi Dalhi Road
Managers Cheque D Demand Draft payable at moyadabad
Favoring.
For amount Rs.
(in figures)
Ohe lakh heusand Rus (In words)
Mode of Payment:-\Cash/Cheque No.
Cash
Purchaser Namne:
Please deliver the Demand Draft / Managers Cheque to Mr /Ms. Whose signature
is appended below

Bearers Signature
ARUN
Customers signature
(Purchaser)
l acknowledge Receipt of the DD/ MC as requested

Signature of Recipient
ARUN
Customers Name
(Purchaser)
" |/ We enclose Cheque No.
drawn on my/our above account in favour of HDFC Bank Ltd.
-1/We Authorize you to Debit my / our above account towards issuance of the above DD/ MC vide Cheque
· |/We further authorize you to debit the aforesaid account for the service charges / tax, as
applicable.
- T/We acknowledge that in case |/ 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 e ect as
multiple debit entries in my /our account
DD/ MC against cash will be issued below Rs 50,000/- to Non- customers and should be accompanied
with KYC documents
For bank Use only
Processed by (Emp code and sign) Mandatory 8anned Dedupe done for DD/ MC Jgaunst cash.
Tick anly if applicable
Authorized by (Emp code and sign)

DD /MC/UTR No Ref No
Charges Recovered Rs (applicable only for Non Customer): Day end Checked by
Transaction Authorized by (2 Level) (for amount >5 lacs).
KYC documentation done by (only for Non-HDFC Bank
Terms and conditions: 1), |/Wehereby authorize
2) /We hereby agree that the aforesaid details HDFC Bank Lld to carry oul the RTGS/NEFTlransaction as por the details mentioned above(Tick the appropnale field)
liability for any consequences Oul of erros Inciaing hel-SC code and the beneficiary account are correct. 3) We further acknowledge that HDFCbank accepls no
infomalion and beneficiary namo particulars will not bo delails provided by me/ us. 4) |/ We agree that the credit will a ected solely on the beneliciary account number
usod lor tho seno 5)|/wO Aullhorizo tho bank todobil my /our beaccount with tho charges plus laxes applicatle for
this ransaction 6)I/We agree thal requesls submitlod alter lhg cut o lino will bo
that the remitting bank shall not be liable for any loss of darnage arising sontinnoxt batch or noxt working1day as applicablo. 7) l/Wohoroby agrcoAs ard undersland
omission, or error in ransnission or delivery hereof or in or resulting from delay in transmission delivery or non-delivery of Electronic messageor any mistake,
destination Bank or any act or beyond conlrol. 8)1/We agree that incase|of theNEFTransactionifwe
mossago from arny cause whatso0veror from its misinterpretalion received or the achon of the
donot have anaccountwith tho bank,we will produce Original identification
proof while giving the request. In case|/We submit form 60, wewill also submit lhe address proof. 9) lncase
transaction less than Rupees Two Lacs through NEFTand reater than or egual to Rupees Two Lacs hroughthe RTGS and NEFT option is not ticked by us, I/We authorize the
RTGS and deb1t charges as applicable.
Customers Copy
(To be produced by customer while collecting
DD/MC from bank)
DD/MC lor Rs Drawn on Bank
Ch No. Seal
Customer Name:
Customers Alc number For HDFC Bank
Request for MC I DD/RTGS and NEFT can also be placed using
Netbanking PTO
 RTGS /NEFT Request Form
RTGS
DNEFT
For RTGS / NEFT Maximum Limit for NEFT Transaction
No Limit
HDFC Bank Customer via Account - Up to INR 200000/
Nepal NEFT Remittance
HDFC Bank Customer - Indo Remittance Up to INR 50,000/
Non HDFC Bank Customer & Indo Nepal NEFT Fund / Others
one (Family Maintenance/ Retirement Fund / Pension
Purpose of Remittance to Nepal - tick
Time
Customers Name ARUN
4214&423216 Chq no
Account no
4419 5o 3 Tel No
Mobile No
Remitter Legal Entity ldentifier Code (LEI)
transacion for non-individual accounts)
('Only applicable for Rs 50 cr &above
LEIExpiry Date: DDM M Y Y YY
Bank Customer)
Address of Remitter (Mandatory for Non HDFC Email id

Amount of
In case of Non HDFC Bank Customer
Cash Deposited
Beneficiary details:
ARUN
Name
MANTHOLI DELHI ROAD MED.
Address GANDHI COMPLEX bPP. MANSAROVER coLoNY
Account No :
y 2 4 6 7 2 3 2 |6
Re-Confirm Account n o : 4 2 | | 4 6 7 2 3 9
COBGNY IFSC Code
Bank Name & Branch: HoFC MANSAROUER
MORADABAD
Alc Type:UResident Non Resident
Beneficiary Legal Entity ldentifier Code (LE)
non-individual accounts)
("Ony applicable for Rs.50 cr &above transaction for
LEIExpiry Date: DDM M Y| YYY

(In Words): ONE LAKH STXTY THoUSAND

Amount to be credited (in figures):bo,000
92929/19
10
2021_MO71
Remarks: purpose of
overleaf. For Indo Nepal remittance. I/we declare that the
I/we agree to terms and conditions mentioned
remittance is for above selected purpose only.
Signature of Authorized signatory

2nd Signatory 3rd signatory

1st Signatory
For bank Use only
Authorized by (Emp code and sign)
Processed by (Emp code and sign)
Ref No
DD /MC/UTR No
Day end Checked by
Charges Recovered Rs (applicable only for Non Customer);:
Transaction Authorized by (2 Level) (for amount > 5 lacs).
KYC documentation done by (only for Non-HDFC Bank Customers)

Customers Copy vido Casth / Chogug numbor

Roceved appl1calion lor R[GS/NEFT lor an amount of Rs Bank
to be credited to Account number Seal
Bank with IFSC Code Customors will be guided by the Terms
consequencos arising out of oronous
arid Conditions mentioned in the form. HDFC Bank w1ll accepl no liability for any For HDFC Bank
details provided by the Customer,
Rpquest for MC IDD /RTGS and NEFT can aiso be placed using Netbanking