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    Nationalized Electronic Funds Transfer: (Formerly Known As Religare Health Insurance Company Limited)

    Uploaded by

    gulam khan
    This document is a request form for Nationalized Electronic Funds Transfer (NEFT) from Care Health Insurance Limited. The insured provides their bank account details including account holder name, bank name, account number, account type, branch address, MICR code, and IFSC code. They have also enclosed a photocopy of a cancelled cheque for verification. The insured declares that the information provided is correct and will not hold Care Health Insurance Limited responsible if the transaction fails due to incorrect details. Care Health Insurance Limited reserves the right to use alternative payment methods besides NEFT.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Nationalized Electronic Funds Transfer: (Formerly Known As Religare Health Insurance Company Limited)

    Uploaded by

    gulam khan
    199 views1 page
    This document is a request form for Nationalized Electronic Funds Transfer (NEFT) from Care Health Insurance Limited. The insured provides their bank account details including account holder name, bank name, account number, account type, branch address, MICR code, and IFSC code. They have also enclosed a photocopy of a cancelled cheque for verification. The insured declares that the information provided is correct and will not hold Care Health Insurance Limited responsible if the transaction fails due to incorrect details. Care Health Insurance Limited reserves the right to use alternative payment methods besides NEFT.

    Original Description:

    Care Form for NEFt mendate

    Original Title

    Care NEFT mandate

    Copyright

    © © All Rights Reserved

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    This document is a request form for Nationalized Electronic Funds Transfer (NEFT) from Care Health Insurance Limited. The insured provides their bank account details including account holder name, bank name, account number, account type, branch address, MICR code, and IFSC code. They have also enclosed a photocopy of a cancelled cheque for verification. The insured declares that the information provided is correct and will not hold Care Health Insurance Limited responsible if the transaction fails due to incorrect details. Care Health Insurance Limited reserves the right to use alternative payment methods besides NEFT.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    199 views1 page

    Nationalized Electronic Funds Transfer: (Formerly Known As Religare Health Insurance Company Limited)

    Uploaded by

    gulam khan
    This document is a request form for Nationalized Electronic Funds Transfer (NEFT) from Care Health Insurance Limited. The insured provides their bank account details including account holder name, bank name, account number, account type, branch address, MICR code, and IFSC code. They have also enclosed a photocopy of a cancelled cheque for verification. The insured declares that the information provided is correct and will not hold Care Health Insurance Limited responsible if the transaction fails due to incorrect details. Care Health Insurance Limited reserves the right to use alternative payment methods besides NEFT.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    Nationalized Electronic Funds Transfer

    Care Health Insurance Limited


    (Formerly known as Religare Health Insurance Company Limited)
    Unit No. 604 - 607, 6th Floor, Tower C,
    Unitech Cyber Park, Sector-39, Gurugram -122001 (Haryana)

    Policy/Proposal Number _________________ (to be filled by Proposer/Insured only)


    Intermediary Code _____________________ (to be filled by Intermediary only)

    I ______________________________________________________________________ in the capacity of (Please tick one)


    Proposer Insured Claimant Hospital Agent Broker
    request you to transfer the payment(s) directly to my Bank account, details of which are mentioned below:

    Particulars of Bank Account

    Account Holder's Name :

    Bank :

    Account Number :
    (Please mention the complete account number as appearing on the cheque book)

    Type of Account : Savings Account Current Account Others (Please specify) : _______________

    Branch Address :

    MICR Code :
    9 - Digit MICR code number of the bank and branch (Appearing on the MICR cheques issued by the bank)

    IFSC Code :
    (Please refer your cheque book or your bank branch for IFCI code details)

    I have enclosed a photocopy of the cancelled cheque or cancelled blank cheque.


    (In case the attached cheque copy does not bear the account holder's name, please provide photocopy of Bank statement or else Bank attestation is required)

    I hereby declare that the particulars given above are correct and complete. If the transaction is delayed or not effected at all for
    reasons of incomplete or incorrect information, I would not hold Care Health Insurance Limited responsible. Further, Care
    Health Insurance Limited reserves the right to use any alternative payout option(s) including Cheque/Demand draft inspite of
    opting for NEFT option.

    Date : / / Signature of the Applicant : ___________________________

    Bank Attestation (If required)


    We certify that the above mentioned account details are correct as per our records.

    Date : / / Sign & stamp of Bank Official : _______________________


    Ver: SEP/20

    Care Health Insurance Limited (Formerly known as Religare Health Insurance Company Limited)
    Registered Office: 5th Floor, 19 Chawla House,Nehru Place,New Delhi-110019 Corresp. Office: Unit No. 604 - 607, 6th Floor, Tower C, Unitech Cyber Park, Sector-39, Gurugram -122001 (Haryana)
    Website: www.careinsurance.com E-mail: customerfirst@careinsurance.com Call us: 1800-102-4488 | 1800-102-6655
    CIN: U66000DL2007PLC161503 IRDA Registration No. - 148

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