EQUEST FORM NEFTIRTGS CUSTOMER PAYMENT f edi to the ACCOUNT OF My / OU als mrenvoned below EE We sanhonze 2 debit to my / our siccount to afluct 3 aely BrCAKONEY wath JHOIELLAAK I stecordance will the del Date of Request t . Name of tho fequestec E Auuiess. ‘Mail ta Contact No.: Contact Person: Account Number: Customertd: UNITED BANK OF INDIA Branch where Alc 14 held. Mumbai Br. { UTsIeGOMGO1 Gliequé Number a Amount to be Transferred jin Figuees): _Samount io be Transferred (Ia Words) RIGSINEFT Charges: __ 4 4. _ RstoRstlac Rso ee zi BE. ULac toRs.2 Lac “Risser = E _ RS.26/- ven RE 55 Benelidiary Details: fefiiliciary Accounting: q | PeaBiigiary Accouni nacie” fa aot sey has Addcess: hold United Bank of tndia their successers and assignees incampiliéd from and against all consequences that may arse (rom such tanster and against all los¢s, charges and expenses in coqneation with the said. téansler theredt, a case of delayed payment (com the Counter party OF , incorrect details of eneficwazy Supplied 10 Udited Bank of lndia. by wer vs Iq €6Asiderauvon of United Bank Of Inara transtecing funds as eo I viz hereby uadertake to WWe hefeby contol wat We tad tead, waderstood and agree to abide and be bound by at tie provisions of the: terms and ‘Eonditions and fulés. of Secvices concerned with the said Serwice offering of NEFTIR IGS ‘ 2 : \ by Hace