Branch office: ____________

Date: _____________

 Please transfer through NEFT (National Electronic Funds Transfer)/RTGS (Real Time Gross Settlement)/MT ________________ for Rupees _______________as under.

Account No. for NEFT/RTGS/Name of Beneficiary	Beneficiary Bank and Branch Name	IFSC (Indian Financial System Code) No./Daft No./MT No.	Amount(In Rupees)	Commission(In Rupees)	Total(In Rupees)

  

Please debit the total amount Rupees ______________ to my SF/CA/OD/CC account or I tender Rupees ___________by cash /enclose chques______________ drawn on ___________

 I agree _____________________________ .

Applicant Name: _________

Applicant Signature______________

Address _____________