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Application Form Fo「 Funds TransFer

NatiOnal ElettЮ 瞑:1問


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Date:11.‖ ■‖■││― ‖│‖ .‖ ■‖│I Branch:
`││::R,han
t"r""t**""*-"**reproceedsasperaeuitsbelowthrough: I
o* I
NEFT fiick on the approPriate Box)

Forで .(Fo「 RTCS,draw the


ALtadhing Cheque No.

cheque Favounng'=Bandhan BankLtd― 耐 'and fO「 NEFtt draWヒ he Clleque肺 unng″ Bandhan BankLLd― NEFTつ

Benefkiary Details

Beneficiary's Name

Beneficiary's Account Number

ReconfirmAy'cNo.

Beneficiary'sAddress

Benef iciary's Bank Name and Brandt

BeneFiciary's Bank |FS Code

Amount(ln figures) to becredited

Amount (ln words) to be credited Rupees only

Remitter DebiL

Remiヒ terslAppucanピ ⇒Name

RemittersAccount Number

C-ash Deposited (Non-Bandhan Bank Customer) t


Phone Number oF the Remitter (trandabory)
Mobile No.
(Mandatoryl
1
IIEffi
Emall:D

Address of the Remitter (Mandalory for any Non-Bandhan Bank Customer)

Acknovtedgment

. Received application for NEFI ForanamountoF {


Mde Cash/Cheque Number to be credited to theAccounヒ NumberoF

BankvЙ thiFSCOde CusLomeswilbe guided bytheTemsand Condiuons menuOned h the Fom.BandhanBankwiuaccepヒ

no uabttwForanyconsequencesadJng outoFerroneousdetaiじ provided bythe Customen


For Bandhan Bank

Daヒ
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Sgnature of theAuthorised Signatorywith Branch Stamp

Page 01
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.l/taEagrledrtEq'rasts$brlMefurtheorEofrdmqwi[bes€r*lnnotbatdorrEturo.titgda,6+plic.ble

.l/t{E}E€tlragrre&understndUretfreRIE9NEFTreqr€Etise&i(tbdleRBlR.gul*ionsddGrktelin6gorerningthesdrE

edion ofthe deadndon Bank oaarU.(t or6En b€yond contsEl

sub.nlt frorm 60, ur. wflabo sibmt the Addr€l6 Proof

.ln66€theRTGsandNEFTordo.rbnottidcdby'rs,l/tnE.uthoriseyouto€EorbetheEansadbnb6sthanRrp€6lurete6SrulghNEFTedgreaErthanoreqralbRrp€6lv,o
L.cs through RTCSaltd d€bt dle dEg€6a appliible

SignatureoFthelstAuthodsedSignatory Signature of the 2nd Authorised Signatory Signature of lhe 3rd AuEhorised SignaLory
(PteaSeaFF挟 stamp口 聰腱ぃ rappucauel (Please af f ix stamp wherewr applicable) (Piease af f ix stamp wtrerewr applicable)

BnndrUseOn$

Transaction Reterence Number

Transaction lnput by (Emp. No)

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Oete&
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Signature

TransactionAutholsed by(Emp.No.)

Signature

KYC

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Documentation done by
Fo「
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NoFBandhan BankcusLomersl(Emp.No)

Signature

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