To, Application for National Electronic Fund Transfer / The Branch Manager Real-Time Gross Settlement Systems (NEFT / RTGS) City UNION BANK pet PAN No. Branch “To be provided by CITY UNION BANK customer Dear sit, Please remit through NEFT/ATGS a sum off ______ (Rupees in words). only aS per delalls given below: Cash Cheque Debit my / our account “In case of cash,please fil in the pay-in-slip ‘To be filled by the Applicant in CAPITAL LETTERS PaaS eG Aecomtnumber | EEE ETT TTT TT Cheque Number I Cheque Date [5 PPP) Remitter's Name Livi, I ti it Address Is] T al I Mobile / Other Number fel eYNKela-T eek Beneficiary’s Name AEE) ‘Account Number Beeneena! Reconfirm Account Number Bank Name iA GPEeeeeee If code (11-digit) Jelslete]2] Branch Address 1 I ey Sender to Receiver information (if any) : PEE RON) * This tranefer ie valid for single traneaction| * Th fund transfor wil be governed by the Terms and Conellons given on our website www. Cay Union Bank.com * Due cae is taken while ling up the beneiciany account number & IFSC code. * Transfer ofan amount upto 49.909 in cash permissible using this tacty * Photo ID proof to be given by non customer for cash payment above. * Please donot ceclose your Account detale/Intemet Barking, UserID and Paseword/ATM debit Car/Great CaraMable Barking Personal Information to any parson. * Do not fall prey to false promises : beware of dubious scheme. DECLARATION ‘Wwe authorise ity Union Bank to recover charges as may be apploabe by debiing my aocount es mentioned above. * we understand that as per the RBI Circular dated October 14,2010, transfer of unde through electronic mode wil be executed only onthe basis ofthe account ‘umber of the beneficiary provided whitening the traneaction. Name wil NOT be conslered asa crtora for providing cre. * understand that this fact Ie avallable only t selec locations and banks covered under Electronic Funds Transfer Facity offered by RBI CUSTOMER SIGNATURE (s) ITTER) 4 4 Signature Signature Signature Name Name Name “(Primary Applicant) “(Joint Applicant 1) “(Joint Applicant 2) Bo Customer Acknowledgment : i We acknowledge receipt of NEFT / RTGS instruction(s). Reference no,—____ Branch : Namie and Signature of Bank Official ie