APPLICATION FORM FOR

Meenalakshmi Benifit Fund Nidhi Ltd STANDING INSTRUCTIONS

Papanasam Date:

I (Account Holder Name) hereby authorize you to debit my/our account for
making through NEFT/Auto Debit to various parties as per the details below:

FROM ACCOUNT DETAILS:

Account Type

Account Number

Account Name

TO ACCOUNT DETAILS:

Beneficiary Account Type

Beneficiary Account Number

Beneficiary Account Name

I/we hereby declare that the particulars give above are correct and complete. If the transaction is delayed or
not effected at all for reasons of incomplete information, I would not hold the user institution responsible.

The bank is authorized to effect the standing instruction of Debiting my/our account along with prescribed
charges until cancelled in writing by me/us.

In accepting the standing instruction it is clearly understood the bank will not be responsible for not carrying
our instructions on account of (i) insufficient balance in the account on the prescribed date and
(ii) Circumstances beyond bank’s control.

I/we understand that the provisions of Section 25 of payment and settlement systems Act, 2007 (Similar to
section 138 of Negotiable Instruments Act, 1881) shall apply to dishonour of electric funds transfer).

SIGNATURE OF CUSTOMER

Standing Instruction Accepted

MANAGER

ACKNOWLEDGEMENT

Received from Shri/Smt/ having SB/current Account No____________

Standing instruction, with the following particulars:

Date: MANAGER