Date:

To,
Paytm Payments Bank Limited
B-121, Ground Floor,
Sector-5, Noida-201301

Sub – Reversal of funds due to wrong IMPS/UPI/NEFT transfer

Dear Sir,

This has reference to below mentioned funds which have been transferred through _______
<IMPS/UPI/NEFT>.

I, _________<name>, certify that I entered the wrong account number while doing the transaction and it has
resulted in transfer of funds to another account (unintended beneficiary). The intended beneficiary of the
transaction is _____<actual beneficiary name>_________________, having an account no.
__________<correct account number>_______ held with __________<bank name>.

This has reference to below mentioned funds which have been transferred through ______.

Date of Beneficiary Beneficiary Beneficiary Beneficiary a/c no Correct UTR Amount

Txn Bank IFSC Code Name wrongly entered Beneficiary a/c No./Bank
while transaction no Txn id

I request Paytm Payments Bank to take up this matter with bank for reversal of the above transaction and
credit back in the Paytm account on best effort basis.

I hereby undertake and agree to indemnify and shall keep ​Paytm Payments Bank indemnified and
harmless, against all claims demands, actions legal proceedings made against ​Paytm Payments Bank by
any person, individual, bank, entity for the stated transaction and losses, costs (including legal fees and
expenses), damages, consequences etc. of whatsoever nature if any, suffered and / or incurred by Paytm
Payments Bank with respect to such refund of aforementioned transaction amounts.

I also undertake that in the event of any dispute on the claim of such transaction and/or inaccuracy,
mismatch of any details submitted by the undersigned, Paytm Payments Bank is authorized to block my
wallet / account till the time the same is settled.

Thanking you,

Yours Faithfully,

Name & Signature:

Mobile number:
Aadhaar number: