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Indian Bank RTGS Form

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Indian Bank

Application for National Electronic Fund Transfer

Real-Time Gross Settlement Systems (NEFT/RTGS)


A NSTTT

To.

Date D D MM
The Branch Manager
PAN No.

ILLL

*To be provided by Indian Bank customer

U
Branch
Dear Sir,
Please remit through NEFT/RTGS a sum of .
(Rupees In words)

only
as per details given below:

Amount .
Cash Cheque Debit my/our account
Commission
*In case of cash, please fill in the pay-in-slip
To be filled by the Applicant in CAPITAL LETTERS
Total.
DETAILS OF
APPLICANT (REMITTER)
Account Number

Cheque Number
Cheque Date DDMMY
Remitter's Name

Address

Mobile/ Other Numer


I
DETAILS OF
BENEFICIARY

Beneficiary's Name

Account Number

Reconfirm Account Number


Bank Name

IFSC Code (11-digit)


Branch Address
Sender to Receiver information (if any):
Terms and
Conditions
This transfer is valid for a single transaction.
SIGNATURE
The fund transfer will be governed by the Terms and Conditions given on our
website www.indianbank.in
Due care is taken while filling up the beneficiary account number & IFSC
code.
Transfer of an amount up to R 49,99 in cash permissible using this facility
Clerk.
Photo ID proofto be given by non customer for cash payment above
Please do not disclose your Account detalls/nternet Banking, User ID and
Passwords/ ATM debit Cardy
Credit Card/Mobile Banking/Personal Information to any person
Do not fall prey to false promises; beware of dubious scheme.
Officer

Declaration
/We authorise Indian Bank to recover charges as may be appllcable by debiting
my account as mentioned above.
wWe understand that as per the RBI Circular dated October 14, 2010, transfer
of funds through electronic mode will be executed only on the basis
of the account number of the beneficiary provided while initiating the
transaction. Name will NOT be considered as a criteria for providing credit
lunderstand that this facility is available only at select locations and
banks covered under Electronic Funds Transfer facility offered by RBI

Customer
Signautre(s)

Signature
Signature Signature

Name Name
Name

*(Primary Applicant) *(Joint


Applicant 1) *(Joint Applicant 2)
-
---
Customer
Acknowledgment

Date

Bank Seal
We acknowledge receipt of NEFT/ RTGS instruction(s). Reference no..

With Date & Time


Branch : Name and Signature of Bank
Official of Request

R.P./2Lakh Forms/11-2021

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