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Application for National Electronic Fund Transfer/
Real-Time Gross Settlement Systems (NEFT/RTGS) y BANK
a Immediate payment Service (IMPS)
The Bronch Head
Branch
Deor Si, “Tob provided by As Bon oor
Pease remit through NEFT/RTGS/IMPS 0 sm ® pect In words
SUSIE AG eral ere eat ‘only at per deals given balow:
[cash (Only for NEFT Transactions upto € 49999/-) [] Cheque] Debit my/our eccount
com of co, aoe in the pops “eather or NET pe doy
‘Yo be filed by he Applicant i CAPITAL LETTERS “WPS rt 2.09 ony
1| Eero
‘Account Number
Cheque Number Chequedate [oT T=T@[e Fe)
Remiters Name eh e ]
le Est J]
Address i L I
Mobile /
Other Number SEE SUEUOE i
2| EER
Been’ Nome CoO
Account Number i a a
Reconfirm Account No| I i
Bonk Nome
IFSC Code (11 digit’ [_] Tasty
Bronch Address I I etale ret
Sender to Receiver information ff on
NEM TERMS AND CONDITIONS
‘This tronsfer evo fora single transection
Ih fund worse wl be govemed by fe Terms ond Condon give on our wabe wu: Asbo. com
{Die core ietoken wie ng up he benef acount number & FSC code
1 ander fon omount vplo € 49,999. neath permis sng NEFT
Prato poole be gen byron, tomer fr coh payment above ~__ gina NEFT
Feo dent ose your Recor! detrene Bnking, Use 1D and Postwora7ATM ceit-Card Credit Cord/Moble Bonking/FesonlInfrmation
+ Borat prey o folie promises; bovars of dubious schome
1 Inccaethe PS tonzochon goes in panding sate fonds moy get Wonslared or revered back within T +2 doy,
1 onto fam mount up € 2,00 00 is parmisebla par IMPS roracton suber! So per oy ors ini os er scheme code
4| EE
7 [Me outer As Banko recove charge os maybe appablaby dbiting my aecou os anon above
Inte version that opr the RS Celr dared Ocober 14,2010 ronal offyndthvough sacronc node lb xed ony on he boi of the ecco
rumba’ of neberecon provided whe rsatnghalanscien Nome wil NOT be conse aro crteslor providing ce
+ Tunderdond et soc ovale ony oanle location ond bonkrcovere und Beenie Func Yor oly fered #8
EME CUSTOMER SIGNATURE(S)
= E ||
ACKNOWLEDGEMENT TO CUSTOMER (ie el
ies te ce ee
Retrnce Neer GSN ovale No (er MS) Fos Slaton Relwerce No For W2S|
Wor Nerve ad Sanco Bork fic i Wi Dat Tine Regus
enters Nome ecu No Chea. = Sat
enc Now Jest Ne is.
mourn Foes Amour n Woe