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NEFT Form

This document is a letter requesting electronic payments through RTGS/NEFT to a bank account. It provides the vendor code, name, PAN number, contact details and address. It also lists the bank account number, bank name and branch, telephone number, email, MICR code and IFSC code. The letter declares that the information provided is correct and complete. It confirms that any charges from the bank for the credit will be borne by the recipient. It also states that the company will not be held responsible if the transaction is delayed or lost due to incorrect information.

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Murali Gandi
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2K views1 page

NEFT Form

This document is a letter requesting electronic payments through RTGS/NEFT to a bank account. It provides the vendor code, name, PAN number, contact details and address. It also lists the bank account number, bank name and branch, telephone number, email, MICR code and IFSC code. The letter declares that the information provided is correct and complete. It confirms that any charges from the bank for the credit will be borne by the recipient. It also states that the company will not be held responsible if the transaction is delayed or lost due to incorrect information.

Uploaded by

Murali Gandi
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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To,

Reliance Jio Infratel Private Ltd


MDM Cell,
SSO-Master Data Management (MDM),
TC 23, A – Wing,10th Floor, WS-279,
Reliance Corporate Park,
Thane Belapur Road, Ghansoli,
Mumbai – 400701

Dear Sir,

Sub: E–Payments vide RTGS/NEFT

I/We request and hereby authorise you to execute E-Payment vide RTGS/NEFT modes to my/Our Bank account as per the
details given below:

1. Particulars of Vendor

A. Vendor code :
B. Vendor’s Name as in the bank :
C. Name of Account holder :
D. Permanent Account Number (PAN) :
E. Contact Person :
F. E-Mail id for payment advice :
G. Telephone/Mobile no. :
H. Vendor’s Address :

2. Particulars of Bank Account


A. Bank Account Number

(As appearing on the Cheque book)

B. Name of the Bank & Branch :

C. Telephone No. with STD Code :

D. Email ID of vendor’s Bank :

E. 9-Digit Bank / Branch MICR Code :

(Mandatory - Please attach a ORIGNAL cancelled Cheque for verification)

F. 11-Digit IFSC Code :

G. Account Type : Current Cash Credit Saving

I/We hereby declare that the particulars given above are correct and complete. I/We confirm that I/we shall bear the charges,
if any levied by my/our bank for the credit in our above account through NEFT. If the transaction is delayed or lost because of
incomplete or incorrect information, we would not hold the company responsible.

Thanking you,

___________________________
Date: Authorized Signatory & Stamp
………………………………………………………………………………………………………………………………..
Bank Certificate
We confirm that the details given above are correct as per our records.

Date: ___________________________________
Place: Signature, Code & Stamp of Authorised Bank Official

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