Professional Documents
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To
Dear Sir/Madam
1 INSURED NAME
2 RESIDENTIAL TEL NO / MOBILE NO.
3 PARTICULARS OF THE BANK ACCOUNT :
a BANK NAME
b BRANCH NAME
c ADDRESS
d TELEPHONE NO.
9-DIGIT CODE NUMBER OF THE BANK &
BRANCH APPEARING ON THE MICR CHEQUE
e ISSUED BY THE BANK
ACCOUNT TYPE – S.B. ACCOUNT(10 OR
31)/CURRENT ACCOUNT(11 OR 29)/ CASH
f CREDIT(13) WITH CODE 10/11/13
ACCOUNT NUMBER (AS APPEARING ON THE
g CHEQUE BOOK)
h IFSC CODE OF BANK BRANCH
I, hereby declare that the particulars given above are correct and complete. If the transaction is
delayed or not effected at all for reasons of incomplete or incorrect information, I would not
hold Oriental Insurance responsible.
(Note :- Insured may attach a blank cancelled cheque or a photocopy there of)
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