Application Form For Funds Transfer Through (RTGS) / (NEFT) I

Application Form For Funds Transfer Through (RTGS) / (NEFT)

To, The Bhuj Mercantile Co-operative Bank Ltd., ______________Branch. Date:-____/____/_____.

I / We request the Bank to initiate Debit in A/c as per details through RTGS / NEFT (as applicable).

I / We want to send Funds to following Beneficiary / Recipient Details

Beneficiary Full Name

Bank Name / Address

City:

Beneficiary A/c No.

Type of A/c

Beneficiary Bank IFSCode. (11 Digit Code) _________0______________

Beneficiary A/c No. (Again)

Amount (in Figures)

Amount (in words)

My / Our Bank Details (Applicant / Remitter)

Remitter Full Name

Remitter BMCB A/c No.

463 Cheque No.: _____________

Remitter Mobile No.

+91- Email Id: ___________@__________.com

I / We have read the below mentioned Terms & Conditions and Agree with the same:-

*I / We hereby authorize BMCB Bank to carry out the RTGS/NEFT transaction as per details mentioned above. *I / We hereby agree that the aforesaid details

including the IFSC code and the beneficiary account are correct. *I / We further acknowledge that BMCB Bank accepts no liability for any consequences arising

out of erroneous details provided by me/us. *I / We agree that the credit will be affected solely on the Beneficiary A/c no. Information, and beneficiary name

particulars will not be used for the same. *I / We authorize the bank to debit my / our account with the Charges plus Taxes (Applicable if any) for this transaction.

*I / We agree that requests submitted after the cut off time will be sent in next batch or next working day as applicable. *I / We hereby agree & understand that the

RTGS / NEFT request is subject to the RBI regulations and guidelines governing the same. *I / We also understand that the remitting Bank shall not be liable for

any loss of damage arising or resulting from delay in transmission delivery or non-delivery of Electronic message or any mistake, omission, or error in

transmission or delivery thereof or in deciphering the message from any cause whatsoever or from its misinterpretation received or the action of the destination

Bank or any act or even beyond control. *I / We hereby indemnify the BMCB Bank and shall keep the BMCB Bank indemnified from time to time and at all times

hereafter from any loss, claim, damage, cost, charge and expenses however caused or arising out of or in connection with the services offered by the BMCB Bank.

*I / We agree and understand that in case the payee branch does not have RTGS/NEFT facility, the funds will be credited back to my /our account as when it is

returned to BMCB Bank. *I/We agree that incase of NEFT Transaction if we do not have an account with the bank, we will produce Original ID proof while

giving the request. In case I/We submit form 60, we will also submit the address proof. *In case the RTGS or NEFT option is not ticked by us, I / We authorize the

BMCB Bank to execute the transaction less than Rs. 2 (Two) Lacs through NEFT and greater than or equal to Rs. 2 (Two) Lacs through RTGS and also debit the

charges (Applicable if any).

Sign of

Authorized

Signatory

____________________ ____________________ ____________________

1

st

Signatory 2

nd

Signatory 3

rd

Signatory

Please Affix Stamp wherever Applicable.

For Branch Use Only

Transaction Entry Inputed by

Employee Name Signature

Branch Stamp and Date

Transaction Authorized by

Employee Name Signature

Unique Transaction Ref (UTR) No.

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

Customer Acknowledgement

Received an application from Mr._____________________________ BMCB-A/c No. ___________________for RTGS / NEFT

for an amount of Rs.________________vide Cheque no._____________ to be CREDITED To A/c No._____________________

with IFSC Code____________________. Customers will be guided by the Terms and Conditions mentioned in the form.

BMCB Bank will accept no liability for any consequences arising out of erroneous details provided by the Customer.

Date:-____/____/_______ Branch Stamp