Axis Bank Rtgs

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RTGS/ NEFT APPLICATION FORM

(Application form to accompany with a chque)


Branch Gondia
Date 1 9 0 1 2 0 2 1
Remitter Details
Account No. 9 1 7 0 1 0 0 4 2 6 6 2 2 9 5

Name of Applicant A J A Y D A D R I W A L

Remitter Addres: G O N D I A
Contact No:(M) 9 3 2 5 5 3 9 2 2 2

E Mail ID: m a h a l a x m i _ e l e @ r e d i f f m a i l . c o m

Beneficiary Details
Name : D E V I D A Y A L S H I V D A Y A L G U P T A
Bank Name: H D F C B A N K L T D
Account Number: 0 9 6 3 2 5 6 0 0 0 0 5 4 5 Reconfirm Account No. 0 9 6 3 2 5 6 0 0 0 0 5 4 5
Bank's IFSC Code: H D F C 0 0 0 0 9 6 3
Mobile No: Landline No.
Amount (In figures): 6 8 0 0 0 0 0 . 0 0
Amount (In Words): SIX LAC EIGHTY THOUSAND ONLY

Payment Details
Enclosed is Cheque No 201011 drawn on my/ our account for Rs. 6,80,000.00 favouring Axis Bank Ltd. Towards the above RTGS/ NEFT transaction. OR

Kindly debit my above account no Yes a No I/ We have read the conditions overleaf and agree to be bound by them.

__________________________ __________________________ __________________________


Authorized Signatores

Tran. ID No.______________________ Entered Verified

RTGS/ NEFT APPLICATION FORM


(Application form to accompany with a chque)
Branch Gondia
Date 1 9 0 1 2 0 2 1
Remitter Details
Account No. 9 1 7 0 1 0 0 4 2 6 6 2 2 9 5
Name of Applicant A J A Y D A D R I W A L
Remitter Addres: G O N D I A
Contact No:(M) 9 3 2 5 5 3 9 2 2 2
E Mail ID: m a h a l a x m i _ e l e @ r e d i f f m a i l . c o m
Beneficiary Details
Name : D E V I D A Y A L S H I V D A Y A L G U P T A
Bank Name: H D F C B A N K L T D
Account Number: 0 9 6 3 2 5 6 0 0 0 0 5 4 5 Reconfirm Account No. 0 9 6 3 2 5 6 0 0 0 0 5 4 5
Bank's IFSC Code: H D F C 0 0 0 0 9 6 3
Mobile No: Landline No.
Amount (In figures): 6 8 0 0 0 0 0 . 0 0
Amount (In Words): SIX LAC EIGHTY THOUSAND ONLY

Payment Details
Enclosed is Cheque No 201011 drawn on my/ our account for Rs. 6,80,000.00 favouring Axis Bank Ltd. Towards the above RTGS/ NEFT transaction. OR

Kindly debit my above account no Yes a No I/ We have read the conditions overleaf and agree to be bound by them.

__________________________ __________________________ __________________________


Authorized Signatores

Tran. ID No.______________________ Entered Verified

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