PERTICULARs NAME OF THE REMITTER (APPLICANT) REMITTER'S ACCOUNT NO.

REMITTING BANKS IFSC CODE CASH AMOUNT TO BE REMITTED (IN FIG) AMOUNT TO BE REMITTED (IN WORDS) ADDRESS CONTACT NO. (M) CONTACT TEL NO. (R) CONTACT TEL NO. (O) REMITTOR'S EMAIL ID BENEFICIARY NAME BENEFICIARY ACCOUNT NO.* CITY BENEFICIARY BANKS IFSC CODE CONTACT NO. (M) CONTACT TEL NO. (R) CONTACT TEL NO. (O) BENEFICIARY ACCOUNT TYPE BENEFICIARY BANK NAME AND BRANCH BENEFICIARY ADDRESS DETAILS/PURPOSE OF PAYMENT CHEQUE DATE CHQ NO. (IF INCLOSED) AMOUNT OF REMITANCE APPLICABLE CHARGES TOTAL AMOUNT BENEFICIARY A/C NOT TO BE INPUTTED AGAIN BRANCH

DETAILS FABTECH TECHNOLOGIES INTERNATIONAL LTD. 912020023075296 UTIB0000020 315200 3215462 testaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa 717 JANKI CENTER OFF VEERA DESAI ROAD ANDHERI 09833981340

account@fabtecheng.com 925468541254687 andheri

ANDHERI

BRANCH:DATE:-

ANDHERI 27/11/2013

RTGS APPLICATION FORM

REMITTORS DETAILS
NAME OF REMITTER (APPLICANT)

F 9 3
A

A 1 2
A

B 2 1
A

T 0 5
A

E 2 4
A

C 0 6
A

H 0 2
A A

T 2 3

E 0

C 7

H 5

N O 2 9 T

L 6 E
A

O G

E U

S T A
A

I I A
A

N 0 A
A

T 0 A
A

E 0 A
A

R 0 A
A

N 0 A
A

A 2 A
A

T 0 A
A

O N

A
CASH

L 1 A 5 A

L 2 A

T 0 A

D 0 A

REMITTER'S ACCOUNT NO. AMOUNTTO BE REMITTED (IN FIG)

REMITTING BANKS IFSC CODE

B A
A

3 A
A

AMOUNT TO REMITTED (IN WORDS)

S
A

T
A

A
A

A
A

A
A

A
A

A
A

ADDRESS

7 0 a

1 9 c

7 8 c 3 o

J 3 u

A 9 n

N 8 t

K 1 @

I 3 f 4 a

C 0 b

N D

CONTACT NO. (M) REMITTOR'S EMAIL ID

CONTACT TEL NO.(R)

CONTACT TEL NO.(O)

o m

BENEFICIARY DETAILS
BENEFICIARY NAME

BENEFICIARY ACCOUNT NO.

CITY

BENEFICIARY BANKS IFSC CODE

A
CONTACT TEL NO.(R)

N D

I
CONTACT TEL NO.(O)

CONTACT NO. (M) BENEFICIARY ACCOUNT TYPE

BENEFICIARY BANK NAME AND BRANCH

BENEFICIARY ADDRESS

DETAILS/PURPOSE OF PAYMENT

PAYMENT DETAILS
KINDLY DEBIT MY ABOVE A/C NO. CHQ NO. (IF INCLOSED) YES NO APPLICABLE CHARGES CHEQUE DATE: TOTAL AMOUNT

AMOUNT OF REMITENCE

BENEFICIARY A/C NO TO BE INPUTTED AGAIN I/WE HAVE READ THE CONDITIONS PRINTED OVERLEAF AND AGREE TO BE BOUND BY THEM AUTHORISED SIGNATORY

BRANCH USE ONLY

MASSAGE TRANSMISSION TRANHSACTION AUTHORISED & FUND REMITTED THROUGH RTGS AS PER DETAILS OF BENEFICIARY GIVEN ABOVE. 1. RTGS SERIAL NO. 3. FINANCE TRAN. ID TRANSACTION ENTERED BY 2. MF NO. 4. APPLICANT SIGNATURE VERIFIED TRANSACTION AUTHORISED BY YES NO

* PLEASE PROVIDE CORRECT BENEFICIARY A/C NO. AS THE CREDIT WILL BE EFFECTED SOLELY ON THE BENEFICIARY A/C NO INFORMATION.

CUSTOMER ACKNOWLEDGEMENT AMOUNT TO BE REMITTED (IN FIG) AMOUNT TO BE REMITTED (IN WORDS) APPLICABLE CHARGES NAME OF REMITTER NAME OF BENEFICIARY BENEFICIARY ACCOUNT NO. & TYPE TRANSFER TIME am/pm