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GKvD›U mvwf©m dig-2 (wnmve eÜKiY Ges iÿYv‡eÿY)

GwU GKwU †gwkb cvV‡hvM¨ dig | Aek¨B Bs‡iRx eo nv‡Zi Aÿ‡i c~ib Ki‡Z n‡e |

ZvwiL: D D / M M / Y Y Y Y kvLv bvg:

mÂqx /PjwZ /GdwW /wWwcGm wnmve bs: -


wnmv‡ei bvg:

PjwZ/mÂqx wnmve eÜ Kib GdwW wnmve eÜ Kib GdwW wnmv‡ei my` cÖ`vb wWwcGm wnmve eÜ Kib
GdwW / wWwcGm wcÖwÝcvj G¨vgvD›U: E GdwW/wWwcGm †gqv` c~wZ©i c~‡e© bM`vqb:

___________________________________________
MÖvn‡Ki AwZwi³ ¯^v¶‡ii Rb¨ ¯’vb (†gqv` c~wZ©i c~‡e© GdwW/wWwcGm bM`vq‡bi Rb¨
Dc‡i ewY©Z PjwZ /mÂqx /GdwW/wWwcGm wnmv‡e (÷¨vwÛs BÝUªvKkb evwZj K‡i I cÖ‡hvR¨ †ÿ‡Î g~j GdwW iwk`/GdwW GW&fvBm/wWwcGm mvwU©wd‡KU, Avwg/Avgv‡`i KZ©„K
Aegy³ K‡i) bM`vqb/my` cÖ`v‡bi/eÜ Kib †ÿ‡Î my`mn (cÖ‡hvR¨ n‡j) RgvK…Z w¯’wZ/ïay my` cÖ`vb, cÖ‡hvR¨ mg~`q PvR© Av`v‡qi ci wb‡Pi wb‡`©kbv Abyhvqx cÖ`v‡bi Rb¨ webxZ
Aby‡iva KiwQ:
GB wnmv‡e A_© ¯’vbvšÍi Kiæb:
‡c-AW©vi
cwi‡kv‡ai aib : BGdwU AviwUwRGm (AbyMÖn c~e©K mswkøó mvwf©m digwU c~iY Ges mshy³ Kiæb- BGdwUÕi Rb¨ †h †Kvb cwigvb Ges AviwUwRGmÕiRb¨ GK j‡ÿi mgvb ev Gi Dc‡i †h †Kvb cwigvb)
Ab¨vb¨-wbw`©ó Kiæb

* hw` MÖvn‡Ki PjwZ /mÂqx/GdwW/wWwcGm wnmve †_‡K w¯’wZ ¯’vbvšÍi wnmve Gi wmwe (MÖvnK cwiwPwZ b¤^i) c„_K nq, †mB †ÿ‡Î AbyMÖnc~e©K H ¯^Ë¡‡fvMx wnmveavixi mv‡_ m¤úK©, bvg I ¯^vÿi cÖ`vb Kiyb|)

¯^Ë¡‡fvMx wnmveavixi ¯^vÿi


B-wUAvBGb Av‡Q: nu¨v bv ________________________
GdwWÕi ‡gqv` cwieZ©b GdwWÕi ‡gqv` c~w©Zi wb‡`©kbvejx cwieZ©b GdwWÕi ‡gqv` I ‡gqv` c~w©Zi wb‡`©kbvejx Dfq cwieZ©b
*GdwW wnmve cybivq †Lvjv n‡e: ïagvÎ Avmj Avmj Ges AwR©Z my` mn
*bZzb ‡gqv` c~w©Zi wb‡`©kbvejx : * bZzb †gqv` : w`b/gvm/eQi
Avmj Ges my` bevqb Kiæb A_ev
ïay Avmj bevqb Ges my` GB wnmve b¤^i G Rgv Kiæb A_ev
‡gqv`c~wZ©‡Z wnmve eÜ Kib I bM`xKibK…Z A_© GB wnmve b¤^i G Rgv Kiæb
* my` Rgv I PvR© Av`vq wnmve b¤^i
‡bvU: GB †gqv`/‡gqv`c~wZ©i wb‡`©kbvejx cwieZ©‡bi mvwf©m digwU we`¨gvb wnmve †Lvjvi dig Gi ms‡kvab wnmv‡e we‡ePbv Kiv n‡e |
wWwcGm Gi wKw¯Í wbqwgZKiY:
e‡Kqv wKw¯Íi msLv : gv‡mi gv‡mi we¯ÍvwiZ :

cÖwZ wKw¯Íi cwigvb : ‡gvU e‡Kqv wKw¯Íi cwigvb :

e‡Kqv wKw¯Í Rgv I PvR© Av`v‡qi wnmve bs-

Avwg/Avgiv Dc‡i ewY©Z wb‡`©kvejx Aby‡gv`b w`w”Q Ges w` wmwU e¨vsK wjwg‡UW Gi mswkøó kZv©w` I kZv©ejx cwicvj‡b m¤§Z AvwQ Ges Avgvi/Avgv‡`i wnmve †_‡K e¨vsK KZ©„K
avh©¨K…Z mKj cÖKvi PvR KZ©‡bi m¤§wZ w`w”Q|

__________________ _________________
cª_g Av‡e`bKvixi ¯^vÿi ‡bvU: wnmve cwiPvjbvi aib e¨wZ‡i‡K - mKj hyM¥ wnmve avix‡K ¯^vÿi Kwi‡Z n‡e| hyM¥ Av‡e`bKvixi ¯^vÿi
FOR BRANCH USE ONLY
If customer wants to receive fund through pay order, please specify
S O L 0 1 4 1 0 0 0 0 3 8
account no. here:
We the undersigned confirm that all the related document(s) are in order as per CBL Ops Manual/SOP/Related circulars and all necessary
approval(s) are taken.

Space for BM approval if CB of FD / Scheme /CASA Recommended by BOM/Designated


Action Taken by CS Official account is different from fund transfer account
(with seal & sign) Official (with seal & sign)
(with seal & sign)

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