t1"R?ftv.

hi State
o ________
Bank of India
Branch (Code)

Application For RTGS I NEFT I GRPT Remittance

_

Date: _

Please remit the sum ofRs. (Rupees _

--.----
As per Details below by debiting my/our Ale. No.

I 1---'-- -[ I ~1_
Name of Beneficiary: :

Beneficiary Account No.:

Destination Bank's Name & Branch:

IF SC Code of Destination Branch :

Amount (in Words) : Rs.

Amount (in Figures) Rupees:

Charges:

Total:

Date of transfer/cash Name of Applicant

Amount:

Scroll No. Add~ss ~ _

Ref. No.

Tel. No. ....,._---

Signature
.
-----------------------------------------. .

Counterfoil

~ ~ ~/State Bankof India

____________ Branch Code. _

Date : ~_..._

Received from __ --~---.;.-----------------------------------....,._------

By ChequelTransferforRTGS/NEFT ON IFSC Code _
Bank: ~ _

Branch: ~ -----------------_-----------------------