NATIONAL ELECTRONIC FUNDS TRANSFER APPLICATION FORM

To
The IPP Cell
PRE-PRINTED ADDRESS OF IPP CELL NECESSARY

_________________________________
_________________________________
Sub : Option for NEFT
Sir,
I am interested to receive my annuity amount through NEFT.
My details are as follows.
(1) Policy Nos

___________________________________________________
___________________________________________________

(2) Name & Address of Annuitant : ____________________________________

_________________________________________________________________
_________________________________________________________________
(3) Annuitants Bank Name : ________________________________________
(4) Annuitants Bank Address : _______________________________________
(5) Annuitants Account Type : Savings/Current/Cash Credit/NRI _____________
(6) Annuitants Account No. __________________________________________
(7) Annuitants Branch IFS Code : _____________________________________
(8) Contact Mobile / Landline No. ______________________________________
(9) E-Mail Id : _____________________________________________________
(10) Do you want to receive SMS/E-mail alert on
payment of annuity to your A/c :

Yes / No ____________

Kindly transfer the amount payable to me under the aforestated policies as per
details stated above.
I have enclosed the following document to this effect. (Please appropriate item)
A. Cancelled cheque leaf
B. Photo copy of the page of Bank cheque/pass book containing details
_____________________
Signature of the Annuitant

Date :