Application for National Electronic Fund Transfer/
dr-ndr To, ils V\ Canara Bank Real-Time Gross Settlement Systems (NEFT/RTGS) Date The Branch Manager Rr'anch PAN NO. - To be provided by Canara Bank Customer Dear Sir, Ptease remit through NEFT/RTGS a sum of On lrr as per detaits give betow :
I curn trcheque * ln case of cash ptease fitt in the pay-in-stip - To be fitted by the Appticant in CAPITAL LETTERS DETAILS OF APPLICANT (REMITTER)
Account Number I
Cheque Number Cheque Date T
Remitter's Name Address [E_ LEI Code:
LEI expiry date: :: 1 Mobite / Other Number
DETAILS OF BENEFICIARY
Beneficiary's Name
Account Number
Reconfi rm Account Number
Bank Name
IFSC Code (11 digit)
LEI Code: I
LEI expiry date:
Branch Address Sender to Receiver I
Terms and Conditions
a transaction. - The fund transfer witl be governed by the Terms and Conditions given on our website wwwcanarabank.com - Due care is taken while filting up the beneficiary account number & IFSC Code. * Transfer of an amount up to { 49,999 in cash permissible using this facitity. - Photo lD Proof to be given by non customer fc.rr cash payment above * Please do not disctose your account details/lnternet Banking, User lD and Passwords/ATM Debit Card/Credit Card/l obite Banking/ Personat lnformation to any person. . Do not fatt prey to fatse promiies, beware of dubious scheme * Banl<shat[notberesponsibleforwrongcreditortransactionsdectined,duetoincorrect/invalidLElCodeorlFSCCodeorAccountNo.orinformation the Declaration * l/we authorise Canara Bank to recover charges as may be appticabte by debiting my account as mentioned abcYe. - l/WeunderstandthataspertheRBl CircutardatedOctober14,T0l0,transferoffundsthroughelectronicmodewi[[ beexecutedontyonthebasis of the account number of the beneficiary provided white initiating the transaction. Name witl NOT be considered as a criteria for providing credit. - ln understand that this facitity is avaitable onty at setect locations and banks covered under Etectronic Funds Transfer facitity offered by RBI
Customer Acknowledgement Date Bank Seal We aknowtedge receipt of NEFT/RTGS instruction(s) for Rs.---(amount). Relerence No. UTR No)
With Date & Time
Branch : Name and Signature of Bank Officiat of Request N F959-ENGiMTUl"401 2/SeP 23 e-ndr il6 gA Canara Bank {r$q ffift+, ftB Birwr rrffir{ s+.fi ftTart surrft tq,"rffi/qrcftSrf$ {g wr}<rr* A-{rt, (:- B qT a E 7 frTi-6 tc :::-! E i aITqT Y-q-drs eTT?rIT tq rq{ eq qfi-<q * *-;rtt Trflfi er{I3q"tuBf 6-{l-Irr qrg p-+r Er+ffilqTl&$a,rq h rna:rq + { .... .( Fqt er6ti t )
