{Bank \sel For HDFC Bank Cheque / Account No. (To be produced by customer while collecting DD/MC from Bank) Drawn DD / MC for Rs. Customer Account No Customers Copy : Customer Name : Date » | HDFC BANK | We understand your word DEMAND DRAFT / MANAGER’S CHEQUE APPLICATION FORM (Application Form to accompany with cheque) Date: Branch : Please Issue : ~~‘ Demand Draft payable at [1 Manager's Cheque Ih favour of For Amount Rs, (ia figures) Rupees —_— (In Words) Payment Mode: (1 Cash 1 Cheque D1 Debit to Account No. + I/We enclose Cheque No. drawn on my/ our above account. * I/We authorize you to debit my/ our above account towards issuance of the above DD/MC. * I/We further authorize you to debit the aforesaid account for the service charges/ tax, as applicable. + WWe acknowledge that, in case Vwe have issued single cheque/ instruction for debit to my/our account for issuing more than one Demand Draf/ Maneger’s Cheque, then the same will effect as multiple debit entries in my/ cur account. ‘Customer Name Signature Please Note: ‘@ I request is placed through bearer, the application needs to be accompanied with a cheque. DD/MC against Cash will be isened below Rs.50,000/-to ‘Non-customers and should be accompanied with KYC documents. For Bank Ure Only Processed By: “Authorised By: Charges Recovered. Ref, No.t Re: DD/MC No.: Day end Checked By:Please deliver the Demand Draft / Manager's Cheque to the bearer Mr. / Ms. whose signature is appended below. | acknowledge receipt of the DD/ MC as requested overleat Bearer’s Signature Signature of Account Holder(s) Signature of Recipient (90678.012015