RTGS Application Form

Please debit my/our A/C No: / /. Date:

Title of A/C:

Currency Amount (in figures)

(ln words)

Please arrange to transfer the above mentioned fund through RTGS (Real Time Gross Settlement) system as per
the details given below:

Name of Beneficiary: Mobile:

Beneficiary's A/C No:

Beneficiary's Bank Name:

Branch Name : Routing No:

Purpose of remittance:

I undertake to abide by the terms, conditions & rules governing the RTGS transactions. l/we also authorize to debit
mylour account for charges (if any) in connection with the above transactions.

Signature of the A/C Holder Signature of the A/C Holder

Transaction has processed as per the transaction profile (TP): Yes/No.

Debit A/C: Credit RTGS Settlement A/C (HO):

Receiving Bank's SWIFT BIC Code:

Receiving Bank's RTGS A/C No:

Receiving Branch's Routing No:

RTGS MsglD:

Maker Checker