PSB Neft Form

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APPLICATION FORM TO BE OBTAINED FROM CUSTOMER FOR RTGS/NEFT

(TO BE FILLED BY THE APPLICANT IN BLOCK LETTER)


Details of sender:

Date: ____________________ Received From: _________________________________________________

Mobile number: ________________________

Details of applicant
(Remitter):
Transfer for NEFT/RTGS

(1) Title of Account: ______________________________________ (2) Account No: ____________________

(3) Type of account (Saving/Current/Cash Credit):Saving________

Details of Beneficiary:

(1) Center/Station: ____________________________ (2) Bank: ____________________________________

(3) IFSC CODE: _____________________________ (4) Bank Branch: _______________________________

(5) Account No: _______________________________

(6) Beneficiary name: ______________________________________________________________________

(7) Amount to be remitted: Rs. _______________________ (8) Bank Charge Rs. ______________________

(Rupees________________________________________) (Rupees_______________________________)

(8) Purpose of remittance: __________________________________________________________________

Remit the amount as per above details by debiting my/our account for the amount of remittance plus your
charges. A Cheque No./ IBR No.: __________________________Dated: __________________________of
Amount Rs.____________________ is enclosed herewith.

I understand the obligations prescribed under NEFT/RTGS Procedural guidelines and shall be bound by it for
transaction originated by me/us.
________________________________________
Authorized Signatory.
-------- -------- -------- -------- -------- -------- FOR BANK USE ONLY -------- -------- -------- -------- --------
--------
Total Rs.______________________________________
UTR NO.:_________________________________ SEQ NO.:_______________________________

Released By Verified By Authorized By

-------- -------- -------- -------- -------- -------- CUSTOMER RECEIPT -------- -------- -------- -------- --------
--------
Total Rs.______________________________________
UTR NO.:_________________________________ SEQ NO.:_______________________________
________________________________________
Authorized Signatory From The Bank (With Seal & Date)

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