Applicotion for Notionol Electronic Fund Tro nsf er/

Reol-Time Gross Seftlement Systems (NEFT/ RTGS) Jft_ AXIS B ANK l

To, Dote l--1-r
The Bronch Monoger
Bronch
PAN tll
'To be provided by Axis Bonk cusJomer
Deor Sir,
Pleose rernil through NEFT/RTGS o sum of { (Rupees ln words)
on ly
os per detoils given below:
f---l^ |
^, ---t
l_lLosn I lLneque [] o"tr;r my/ our occounl
'ln cose of cosh, pleose fill in the poy-irr-slip
'To be filled by the Applicont in CAPITAL LETTERS

Accounl Number

Cheque Number
Renritfer's Nome
tti
Address

Mobile / Other Number

TJ
t:_)
Beneficiory's Nome

Accounl Nunrber

Reconfirm Accounl Number

_-r*-I-
---_-l---1--=r-i-T
Bonk Nome --l
r-- r-l- l- r-_-l---._l
IFSC Code (1 l-disit)
Bronclr Address

Sender to Receiver informotion (if ony)

This trcn3_fer is volid for o single lronsoclion.

The furid trons{er. will be governed by the Terms ond Condirions grven on our website wwvr ox,sbonk
co'r
Due qore is loken while filling up the beneficiory occounl number & IFSC code
nt tJp { 49,999 in cosh permissible using lhis
given by non custonrer for cosh poyment ob
e your Account detoils/lnternet Bonking, User t Cord/Credit Cord/Mobile Bonking/personol
erson
Do rrot foll prey to folse promises; bewore of dubious schenre

tr l/We ouihorise Axis Borrl< 1o recover chorges os n'loy be opplicoble by debrirng my occounl
os rlenlroned obove
l/We underslorrd lhot os Per the RBI Circulor dcrted Oclober 'l4, 20lO, tronsfer of funds through
eleclronic nrode will be execured only orr
the bosis of the occounl number of the beneficiory provided wlrilo.irpitioting ihe ironsoclion.
Nome will Nor be conside'ed os o criterro for
provlorno credtl
i thol this focility is ovcriloble only ot selecl locollions ond bonks covered under Electr.onic Funds Tr.crnsfer
'ndu"t-ond focilily offered bv
,-]
Isl
RBI

ll

l.l ai i:1 {:'

'ti{) , i ti:
'(Primory Applicont) "Uoint Applicont 1) '(Jornl Applicorrt 2)

Dole CUSTOMER ACKNOWLEDGMENT

-__-=.-=--\.
We qcknowledge receipt o{ NEFT / RTGS insiructiorr(s). Reference n<; \ Bonk Seol
Brorrch Nome sni gignorure of Bonk officiol
Wilh Dote & Tirle
lf Remitler's Nome Account No. oI Request
Cheque No
rl1
Beneficiory Nome Account No. IFSC Code

Arnount (ln figures) Arlorn, llrr Word<\

I

_) I