Application For Funds Transfer-Rtgs/Neft

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APPLICATION FOR FUNDS TRANSFER- RTGS/NEFT

To, Date:01/09/2022
The Branch Manager,
GORAKHPUR Branch

Dear Sir/ Madam,


Please remit a sumofRs.2,11,930 (Rupees TWO LAKH ELEVEN THOUSAND NINE HUNDRED THIRTY) only as per details given
below and debit the amount with your charges to my/our accountwith you.

DETAILS OF APPLICANT DETAILS OF BENEFICIARY


NAME :SWAPNA ROY IFSC CODE:SBIN1203
ACCOUNT NO.8711165716 BANK:STAT BANK OF INDIA
TYPE OF ACCOUNT : HSS/CD/CC/OD BRANCH:RAKHIYAL
CUSTOMER ID NO.61771717 ACCOUNT NUMBER:34593156200
ADDRESS:OPP DOMESTIC AIRPORT, VILLEY PARLE, MUMBAI REPEAT ACCOUNT NUMBER:34593156200
TYPE OF A/C HSS/CD/CC/OD
TEL/MOBILE NO. NAME :DEEPAKKUMAR TIWARI
E-mail ID: TEL.NO./MOBILE NO. :7016463731
SENDER PAN NO.QPDK278Q
SENDER LEI NO. (for non-individual customer) for txn.
value Rs.50,00,00,000/- (Rupees Fifty Crores) and above:
RECEIVER LEI NO. (for non-individual customer) for txn.
value Rs.50,00,00,000/- (Rupees Fifty Crores) and above:
Terms & Conditions
 This transfer is valid for a singletransaction.
 Due care is taken while filling up the beneficiary account number & IFSCCode.
 Transfer of an amount up to Rs.49,999/- in cash permissible using thisfacility.
 Photo ID proof to be given by non-customer for cashpayment.

Yours Faithfully,
For OfficeUseonly (Applicant’sSignature(s))

Applicant’s Signature(s) Verified by: S.S.No. (Maker): S.S.No. (Checker):


Signature : Signature :

S.S.No. Officer-HSS/CD/CC/ODDeptt. Date Time: Date Time

Transaction Reference No. :

Acknowledgement

Received applicationfrom(Name) HSS/CD/CC/ODA/CNo.


Rs. on(Date) atTime
for funds transfer under RTGS/NEFT. ReferenceNo.

Seal Signature ofOfficer

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