Siilisequent.
Disbursenient Request Form
(For Home LoannAp)
' Date: RIR:1 °I tiA§I7
,24?,
.Place A o t; 6 '0 Loan A/c No. l_f_ii-MLoilorol 3 -0-9- aLSISlat_l
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Customer Name a_. 1-1) \t‘q as i _i •-j
Property.asldress 0 1,3 sz) 1-2,affav s
R,_z_v toga_ tjJcj2-r_r2L) s ((Ls,- C_D G.--v a a c,
City puriorE---ar—)C2) (:)' D State Cr U PIN Code 13.1EI•2 I 01
1
Mobile Number II I Reg. Email ID
I
..Disbursement Details
Builder demand/requirement (if self-constructed)
I.
I I I have submitted original builder demand letter/requirement letter (if self-constructed).
I/VVe hereby authorize bank to disburse an amount of as per below:
•
I
rigkOndagt.. ,E1 DetaiLs for -disbursement throligh- Demand Draft: (Nlarkas NA' if not apPlicable) , _
66"64 (ii: ,.) Ake• '
f 41.fettneAl.DP,If.k.97YrrYitiMi.t n41Z•iit '!;.ks--"Ifkat.,Wiral aviga...:Ke41
ESINIT6.1ftr•411MIWZIlkzafi
1 . F 10 Rn R Uu OW)'\ - Ne..SH
f).() -- t-",-L,DR.M
'2 14 E-- MI:14 cel NA U ft P)Ak) C0,0 p. 6,1AR?
1 :0 b441)uloo6535
1._w: too, ,
3 . J •
4 Internal - TATA AIG GENERAL INSURANCE CO. LTD (Property Insurance) I i
4 4 7 116q I
I , . Total Amount 6. ,12 , ti
it4425eliatilAWKWv1Detaili- For-disbursement through RTGS/NEF,T/TraiTsfei: NA if ii-ofirgilicable)fdAWrOilfaire
I.,7..;;,ez".61.jifiz .11,;:ittx.4D.4" .....il,...4.,,,
u,;,,?. {.Favoring Detaiis 21w.t.,.:•..)1
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RTGS/NEFT/Transfer - • i 'I . -•
.
Beneficiary Name • • I ..
. ' ,..
Bank Name I
. . . 1 .
Bank A/C No. . i
_ . . -
RA/ D isb./ App. Form / Feb. 2020/ Ver - I
IFSC CODE - In capital letters I 11
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I II di I 1 Lir 1F1
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Disbursement Amount (in Z) . ., 1
611Z5bAlft..WW. I.r.itgillgegt4ENIMIlifo-rn-i.itiojiti5BOWOVie-riX,1==.11
In every demand raised by the builder, customer will have to make payment tqwards his own contribution (e.g.- If the Property value is 10 Lakh ,
3 lakh is your contribution and Loan amount is 7 Lakh For every demand that builder raised for part of 7 lakh, customer will also pay part of 3 lakh).
Customers also need to submit his/her contribution payment receipts along with disbursement request form.(Please ignore this if your own
contribution is paid upfront and receipts are already submitted)
,
I
Rarzwagzi—drama..a
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I/We hereby declare that the above particulars and information given in the' form are true and correct. I have submitted original receipts of my
payment to builder/developer/ towards self-construction along with this request.
Yours Faithfully,
signature Verified t.
For Axis Bard( L
..... .. ... .......
.. ....
....
ARC HAN .....
POA holder • • )._cr
...........
Emp.
. ........... MP`
designation .. Ati!EpABAD RAC
Loan Centre
Date ............... •
For more details on Part Disbursement, visit Axis bank website for FAQ's or Call us on 1860-419-5555/1860-500-5555 0000i charges apply)
'
.r
Ganesh Flora, B/s. Ganesh Elite, B/h. Ratna Paradise, Nr. Petrel Complex, Nr. Jundal Under Bridge, Vaishnodevl Circle, Ahmedabad.-382210. Call: +91 98790 98823 I 98251 06006 I 99136 22122
Block No : 'R Flat No. • IO 2. Date • 2014-P1-3 No • 173
Received with thanks from M/s. At (410.) 5ntga3t5licti
the sum of rupees (in words) r 4 9 04%1 9-Cra5el'Od ard7 —
by Cash / Cheque /Draft No. C)0009,g' Date:
Drawn on Bank. Hive Be,,,„k Branch .•
FOR, FLORA BUILDCON
Page No .: 1
Account Br'anch : KALOL
We understand your world Address : GROUND FLOOR
NAVJIVAN BAZAR,
NAVJIVAN MILL COMPOUND
City : KALOL 382721
MR. V1SHAL S SODHIYA State : GUJARAT
41 PUJAN BUNGLOWS Phone no. : 18002026161
NR RAJDHANI TENAMENT OD Limit : 0.00
Currency : INR
Email : vishalsodhiya7727@gmail.com
KALOL 382721 Cust ID : 54077544
GUJARAT INDIA Account No : 50100034224198 VRM POTENTIAL
A/C Open Date : 26/12/2014
JOINT HOLDERS: Account Status : Regular
RTGS/NEFT IFSC: HDFC0000894 MICR: 380240029
Branch Code : 894 Product Code: 100
Nomination: Registered
From : 01/07/2023 To : 24/07/2023 Statement of account
—
Date Narration Chq./Ref.No. Value Dt Withdrawal Amt. Deposit Amt. Closing Balance ,
—,
09/07/23 ATW-512967XXXXXX0114-S I AWGJ29-GANDHINAGA 0000000000007570 0/07/23 15,000.00 866,946.22 ;
12/07/23 UPI-LOKHIL SATISH BACHUB-9033195955@YBL- 0000319350211266 12/07/23 5,000.00 861,946.22 '
CORP0000613-319350211266-PAYMENT FROM PH
ONE
18/07/23 CHQ PAID-MICR CTS-MU-FLORA BUILDCON GANE 0000000000000028 18/07/23 20,000.00 841,946.22
18/07/23 POS 512967XXXXXX0114 TOYOTA TSUSHO C 0000319945065747 18/07/23 36,536.00 805,410.22
STATEMENT SUMMARY :-
Opening Balance Dr Count Cr Count Debits Credits Closing Bal
881,946.22 4 0 76,536.00 0.00 805,410.22
Generated On: 24-Jul-2023 12:45 Generated By: 54077544 Requesting Branch Code: NET
This is a computer generated statement and does
not require signature.
FIDFC BANK4AMITED
*Closing balance includes funds earmarked for hold and uncleared funds
Contents of this statement will be considered correct if no error is reported within 30 days of receipt of statement.The address on this statement is that on record with the Bank as at the day of requesting
this statement.
State.account branch GSTN:24AAACH2702H1Z6
HDFC I3ank OS] IN number details are.available atlittps://www.hdfcbank.com/personal/making-payments/onlinedax-payment/goods-and-serviee-tux.
Registered Office Address: HDFC Bank House,Senapati Bapat Marg,Lower Parel,Mumbai 400013
