Application form for Third Party Funds Transfer through Internet Banking

Andhra Bank

To, The Manager ..Branch Dear Sir,

Place: Date:

Sub: Providing Third Party Funds Transfer Facility through Internet Banking I have been availing Internet Banking facility with your Bank. I wish to apply for the Third Party Funds Transfer facility through Internet Banking. I am aware that the usage of Andhra Bank INFInet Internet Banking service is governed by the terms and conditions which are displayed on the banks website www.andhrabank.in maintained by the bank. I have read the terms and conditions applicable to the bank accounts as displayed in the banks website and agree to abide by the same. Please provide me with the Third party funds transfer facility as per bank rules. I (the user) accept that I will be responsible for keying in the correct account number(s) for the funds transfer request. In no case, Andhra Bank will be held liable for any erroneous transaction(s) incurred arising out of or relating to the user (I), entering wrong account number(s) or for such other errors resulted from operation of the account by me wrongly and loss thereby. Yours faithfully (SIGNATURE OF THE CUSTOMER) Account No:
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Recommendations of the Branch:

Customer ID:

I have verified the signature of the customer with the specimen available with the branch and found to be correct. I recommend for providing third party transfer facility to this customer. Place: Date: Branch Seal

(SIGNATURE OF THE OFFICER/MANAGER) Name: S.S.No: Branch Code: