For CUSTOMER IN THEIR LETTERHEAD

Date :-
To,
HDFC Bank Ltd,
Goregaon Branch,
Mumbai - 63.

Dear Sir,

We hereby authorize you to debit our account/s, to process an outward remittance

and remit by way of SWIFT or issue Demand Draft as per details mentioned below:-

Account to be debited

Account to be debited for charges ( ) on us a/c no ____________________

( ) Net off i.e. On beneficiary

Currency and Amount to be remitted

Beneficiary name and address

Beneficiary Bank ACCOUNT NO

Beneficiary Bank name and complete address

Swift code / ABA / Routing no / Sort code

Correspondence bank name and complete address

Swift code / ABA / Routing no / Sort code

Foreign bank charges ( ) to our account

( ) to beneficiary account

PURPOSE

SPECIAL REF NO TO BE MENTIONED IN SWIFT /

outlet no
Rate / contract booked with treasury if any

Regards-
for

Authorised signatory