APPLICATION CUM DEBIT AUTHORITY FORM FOR RTGS / NEFT TRANSFER _ANDHERI (EAST) BRANCH ;

DATE :06.09.16
1 NEFT * Minimum value per RTGS transaction is Rs. 2 Lacs
2 201001016834
3 SBBRSAA & COMPANY
4

Kindly furnish the credit instruction details

Beneficiary Bank Beneficiary Beneficiary Branch IFSC Re-confirm Beneficiary Amount ( In

Name Bank Branch Code Beneficiary Account Number* Account Number Beneficiary Name Figures )

BANK OF BARODA COLABA BARB0COLABA 3910100021922 AMOL SURVE 11234

RAJESH RAJBHAN
BANK OF BARODA COLABA BARB0COLABA 3910100015731 SINGH 14800

BANK OF BARODA COLABA BARB0COLABA 3910100015808 VIRENDRA SINGH 14800

BANK OF BARODA COLABA BARB0COLABA 3910100015719 SATISH GURAV 14534

BANK OF BARODA COLABA BARB0COLABA 391010001713 RAMESH DUBEY 13800

BANK OF BARODA COLABA BARB0COLABA 3910100017226 GHANSHYAM PANDEY 5600

Total Amount Rs. In 74768.00

Total Amount Rs. W Eleven lac forty eight thousand four hundred thirty four only

*RTGS / NEFT Credits will be executed soley on the basis of beneficiary account number/s provided . Beneficiary name will NOT be validated for processing credit instructions.

Remit the amount (s) as per above details , by debiting my / our account for the above mentioned amount (s). We confirm having read the Terms of remittence
on the reverse / attached herewith.

Authorised Signatory/ies / Seal

Customer Acknowledgement Form

Payment Type RTGS ECN No. & Signature Branch Seal

Date: TIME
Cheque No.
Total Amount Remitte 74768.00
Eleven lac forty eight thousand four hundred thirty four only

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 APPLICATION CUM DEBIT AUTHORITY FORM FOR RTGS / NEFT TRANSFER _ANDHERI (EAST) BRANCH ;
DATE :06.09.16

FOR BANK'S USE ONLY

Signature Verified b Logged by Reviewed by

Authorised by Bank's Outward Reference No.

Conditions for Transfer

1 We have checked the funds transfer instructions/particulars given in the application.

2 We understand that the messages given after cut-off time as agreed will be sent only on the next working day.

3 The transfer is effected for legitimate business needs.

4 We shall ensure availability of funds properly applicable to the payment order before execution of the payment order by the Bank.

We understand that in case the payee branch does not have RTGS/NEFT facility, the funds will be credited back to our account immediately when it is
5
returned by RBI to IndusInd.
We also agree to abide with all the other terms and conditions rules/ regulations governing NEFT / RTGS transactions as enumerated by RBI / Laws
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of India.

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