F. No.

:3006

S
To,
*"rn atak-r".p31 [. Ltd.
Your Farnily Bank, Across India
Application for NEFT/RTGS
Date

PAN No.
The Branch Manager
DI d: iLtn
Dear Srr,
Please remit through NEFT/R|CS a sum of (Rupee in words)

onlv as oer tire details siverr bclow.

n Cash fl ch"q,r"
* Lr case cf cash, please fili in the nay-in-slip. *To be filled by the applicmt in Capital letters

Accou-nt Number:
Cl"reque Number : Cheque Date
Remitter's i{ame :

Address :

Mobile / Other N
Number :

Beneficiary Name :

Accourt Number: .Type of Accoulrt (SB / CA / OD):

BankName : Code (11 digit)

Branch Address --___IFSC

Sender to Receiver Information (if any) :

* This transfer is valid for a single transaction.

* Dne care is taken while filling up the beneficiary account number and IFSC Code.
.t Transfer of an amount below Rs. 50,000/- in cash permissible using this facility.
n Photo ID proof to be given by walk in customer for sucl.. cash receipt.

.i. I/We authorise Karnataka Bank to recover applicable charges as mav be by debiting mv account as rnentioned atrove.
* I/We understand that as per the RBI circrrlar dated October 14. 2010, transfer of fr.rnds through eiecironic mode rviil be executed
only on the basis of the beneficiary account number and IFSC code provicled while initiating the transaction arrd Bank will no way be
liable due to incorrect information fumisheci. Narne will NOT be considered as a criteria for proviciing credit.

. SICIAi-UiiE
(Primary Applicant) [oint Applicant 1) (Joint Applicant 2)

Customer Acknowledgement
Date :
Customer Name
Branch
We acknowledge receipt of NEFT / RTGS instructions :.UTI{ No.

Name and signature of the Bank Official

Terms and Conditions for RTGS fund transfer:

It is the responsibility of the sender to ensuie the correctness of the beneficiary details, especialiy the beneficiary Branch IFSC & beneiiciarv
account number. The beneficiary Bank as well as the receiving Bank will get the valid discharge if the amount is credited to the furnished
account number even if the name of the beneficiary accouni holder drffers. The Bank shall not assume any liability arising or-tt of such incorrect
deiails. The Bank shall not be liable for delay/non-payments to the beneficiary due to:
1) Incorrect and Insufficient beneficiary details furnished by the sender.