State Bank of Bikaner & Jaipur ___________________(Branch)__________(Code)

Format of application to be obtained from the customers for RTGS (Real Time

Gross Settlement System) funds transfer and Debit Authority for the same
To:

The Branch Manager

_____________________ Branch

I/We wish to transfer a sum of Rs._____________________________

(Rupees______________________________________________ only) to (Beneficiary's
name) __________________________________________________________ Account
Number_________________________ maintaining account with ________________ branch
of _________________ Bank (IFSC Code__________________ ) using RTGS facility.*

The payment relates to (give purpose of remittance) ________________________________.

I/We understand that if there is a local holiday at the PAYEE BRANCH, the funds will be
credited to the beneficiary's account only on the next working day.
I/We understand that in case the payee's branch does not have RTGS facility/IFSC/any of the
above particulars furnished by me is wrong, the funds will be credited to my/our account as
and when it is returned to State Bank of Bikaner & Jaipur.

I/We authorize you to debit my/our account __________________ with your branch by
Rs.______________ (Rupees________________________________only) towards transfer
of funds under RTGS for Rs.___________________ together with charges of Rs._________.

* I/We have verified the beneficiary account number and the ISFC of the beneficiary's
Bank/Branch and I/we again confirm that the Beneficiary's Account No. is
___________________________________.

I/We understand that in terms of Reserve Bank of India (RBI) Circular No. DPSS (CO) EPPD
No. / 863 / 04.03.01 / 2010-11 dated October 14, 2010 all the Electronic payment products
e.g. RTGS/NEFT/NECS/ECS/SBGRPT will be credited to the Beneficiary’s account at
destination Bank based solely on Beneficiary’s Account Number given by me/us. I/We also
understand that as the process of recovering an amount transferred inadvertently to an
unknown recipient due to incorrect account number, is never within Bank's control, Bank does
not accept any responsibility to recover such funds.

Signature of the customer____________________________ Date____________

Account Number _______________________________
Name: ____________________________ Address: _____________________________

For Bank's Use only

Branch Ref.No._______________________ Date:_________________

Rs.____________________ Rupees (in words) ________________________________

debited to Applicant's A/c No._______________________________ RTGS Message (R-41)
sent on_____________ at ______A.M./P.M. UTR No.___________________________.

Signature of Passing Officer____________________________________