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NEFT/RTGS Payment Form

This document is a paying-in slip for an electronic funds transfer via NEFT/RTGS from Bank of Baroda's Nizampura branch. It provides details of the transaction including the sender's account number and name, recipient's bank and account number, and an amount of Rs. 40,000 being transferred. The customer signatures confirm the request to make the funds transfer and acknowledge the bank's terms including no liability for delays or errors in transmission.

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Ashish Parmar
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5K views1 page

NEFT/RTGS Payment Form

This document is a paying-in slip for an electronic funds transfer via NEFT/RTGS from Bank of Baroda's Nizampura branch. It provides details of the transaction including the sender's account number and name, recipient's bank and account number, and an amount of Rs. 40,000 being transferred. The customer signatures confirm the request to make the funds transfer and acknowledge the bank's terms including no liability for delays or errors in transmission.

Uploaded by

Ashish Parmar
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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BANK OF BARODA BANK OF BARODA

ANNEXURE – II PAYING – IN – SLIP FOR NEFT / RTGS Form No. 404

NIZAMPURA
Branch_______________________ NIZAMPURA
Branch___________________ 16/03/2020
Date______________________ Time of Receipt ____________

16/03/2020
Date ________________________ (FOR RTGS – AMOUNT MUST BE FOR ` 2 LACS OR MORE )

COUNTER FOI L Application for Electronic Funds Transfer to a customer of another Bank through RTGS/NEFT. (to be filled in by customer)

Sender’s a/c no. 34870200000503 Sender’s a/c no of base branch 34870200000503


Name of a/c holder YOGI SECURITY SERVICE Name of a/c holder (sender) YOGI SECURITY SERVICE
NEFT / RTGS: RTGS NEFT / RTGS:
Favouring(payee) Name Favouring/beneficiary (Name)
YOGI SECURITY SERVICE YOGI SECURITY SERVICE
______________________________________________________________________________
Bank: STATE BANK OF INDIA Receiving Bank Name: STATE BANK OF INDIA
Branch: NANDESARI Receiving Branch Name: NANDESARI
IFS Code: SBIN0006614 Receiving Branch IFS Code: SBIN0006614
Beneficiary a/c no: 35937629526 Beneficiary a/c no: 3 5 9 3 7 6 2 9 5 2 6
Beneficiary a/c type: C/A Beneficiary a/c type: (SB/CA/OD/CC/NRE/Credit Card)/Remittance to Indo Nepal C/A
C/A Message for beneficiary (applicable for RTGS only)
Amount ` 40000 Amount ` 40000
Exchange ` Exchange `
Total amount ` 40000 Total amount ` 40000
Total amount in words Total amount in words Forty Thousand only

Beneficiary a/c no: 3 5 9 3 7 6 2 9 5 2 6


Forty Thousand only nd
( to be written 2 time as per RBI guidelines)
I /We request you to make the above remittance. It is being understood that the remittance is to be sent at my/our own risk and
Signature of Customer my/our responsibility and on the distinct understanding that no liability whatsoever is to attach to the Bank for any loss or
9825060216
Tel/Mob No.__________________ damage arising or resulting from delay in transmission, delivery or non delivery of the message or for any mistake, exchange or
ABDPV8907D
PAN ________________________ error in transmission or delivery thereof or in deciphering the message from whatsoever cause or from its misinterpretation when
received or from failure to properly identity the persons name. I/We also hereby undertake to refund to bank any over remittance,
which is made as per RBI RTGS/NEFT scheme.

Bank’s Seal 34870200000503


Please remit the amount as per above details by (i) debiting my/our SB/CA/OD/CC/NRE/ a/c No._________________________ with
NIZAMPURA
________________________ 000007
Branch (ii) I/We herewith tender cheque No ______________ drawn on our a/c towards its cost
including Bank charge.

Sign. of Clerk/Cashier/Teller Signature of Customer Sign. of operator sign. of officer Sign. of officer
9825060216
Tel/Mob No._________________________. (who created mesg.) (who authorized) ( who verified)
PAN _______________________________.

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