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ELECTRONIC PAYMENT REQUEST FORMAT (NEFT/RTGS) (TO BE FILLED IN CAPITAL LETTERS) All Fields are Mandatory EIP VENDOR

CODE (Refer the PO to know your vendor code) Name of the Organization & Complete postal address with PIN Code & E-mail id. ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________

Contact No:

STD Code Phone No

Type of Organization Public Limited

Proprietary Private Limited

Partnership Firm Others

If, it is a Partnership Firm, please ensure that all the Partners sign in this Format. Bank Name: _____________________________________ Pan No:________________________________ Full Bank A/C No: (Should not have any prefix or suffix with alphabets, words, hyphen, bar, coma or full stop.) Type of Account Please tick in the box Current Cash Credit Others Specify

Bank Branch Code: (Nine digits MICR code Appearing next to cheque no.) Bank Address: (Complete postal address)

(Please attach a copy of cancelled or blank cheque) _______________________________________________ ______________________________________________

Pin: If your Banks branch is having Electronic payment facility (NEFT & RTGS), please interact with your banker and furnish IFS Code in the box given below. This is the easiest, reliable & fastest mode of payment and the fund will be directly credited to your account. (RTGS takes 2-3 hours, NEFT same day) IFS Code (Eleven digits) We hereby accept to receive our payment through Electronic Fund Transfer system. We shall intimate to you immediately in case of any change in the above particulars. (Name & Signature by Authorised Signatory with Seal) Place: Date: --------------------------------------------------------------------------------------------------------------------Please contact us at myeft@lntecc.com for any further clarifications. Courier the Original filled EFT format & cancelled Cheque to below mentioned address. Larsen & Toubro Limited, SSC Accounts Payable,ECC Division,HQ Accounts, Mount Poonamallee Road,Manapakam,Chennai-600089. Ph : 044-22526818

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