Application for National Electronic Fund Transfer/

dr-ndr
To,
ils V\ Canara Bank Real-Time Gross Settlement Systems (NEFT/RTGS)
Date
The Branch Manager
Rr'anch
PAN NO.
- To
be provided by Canara Bank Customer
Dear Sir,
Ptease remit through NEFT/RTGS a sum of
On lrr
as per detaits give betow :

I curn trcheque
* ln case of cash ptease fitt in the pay-in-stip
- To be fitted by the Appticant in CAPITAL LETTERS
DETAILS OF APPLICANT (REMITTER)

Account Number I

Cheque Number Cheque Date T

Remitter's Name
Address
[E_
LEI Code:

LEI expiry date: :: 1 Mobite / Other Number

DETAILS OF BENEFICIARY

Beneficiary's Name

Account Number

Reconfi rm Account Number

Bank Name

IFSC Code (11 digit)

LEI Code: I

LEI expiry date:

Branch Address
Sender to Receiver I

Terms and Conditions

a transaction.
- The fund transfer witl be governed by the Terms and Conditions given on our website wwwcanarabank.com
- Due care is taken while filting up the beneficiary account number & IFSC Code.
* Transfer of an amount up to { 49,999 in cash permissible using this facitity.
- Photo lD Proof to be given by non customer fc.rr cash payment above
* Please do not disctose your account details/lnternet Banking, User lD and Passwords/ATM Debit Card/Credit Card/l obite Banking/
Personat lnformation to any person.
. Do not fatt prey to fatse promiies, beware of dubious scheme
* Banl<shat[notberesponsibleforwrongcreditortransactionsdectined,duetoincorrect/invalidLElCodeorlFSCCodeorAccountNo.orinformation
the
Declaration
* l/we authorise Canara Bank to recover charges as may be appticabte by debiting my account as mentioned abcYe.
- l/WeunderstandthataspertheRBl CircutardatedOctober14,T0l0,transferoffundsthroughelectronicmodewi[[ beexecutedontyonthebasis
of the account number of the beneficiary provided white initiating the transaction. Name witl NOT be considered as a criteria for providing credit.
- ln understand that this facitity is avaitable onty at setect locations and banks covered under Etectronic Funds Transfer facitity offered by RBI

Customer Signature(s)

Name Narne Name

.(Primary Appticant) .(Joint Appticant 1
.(Joint Appticant 2)
)

Customer Acknowledgement
Date
Bank Seal
We aknowtedge receipt of NEFT/RTGS instruction(s) for Rs.---(amount). Relerence No. UTR No)

With Date & Time

Branch : Name and Signature of Bank Officiat
of Request
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