Application Form For Funds Transfer Through

Real Time Gross Settlement (RTGS) / National Electronic Funds Transfer (NEFT)
Branch Code / Name NAVRANGPURA Maximum Limit for NEFT Transaction
Date 07/03/2024 HDFC Bank Customer No Limit
Time Non HDFC Bank Customer & Indo-Nepal NEFT Remittance Up to INR 50,000/-

You are requested to remit the proceeds as per details below through RTGS ✔ / NEFT . (Tick  the appropriate Box) .
000014
Attaching Cheque No. ________________ 200000.00
for Rs.__________________________. (For RTGS draw cheque favouring “HDFC Bank Ltd – RTGS” and for
NEFT draw cheque favouring “HDFC Bank Ltd – NEFT”)

Beneficiary Details
Beneficiary Name JAYANT SOMABHAI PATEL
Beneficiary Account Number 066013001002741
Beneficiary Account Number 066013001002741
Beneficiary Address AHMEDABAD
Beneficiary Bank Name & Branch THE AHMEDABAD MERCANTILE CO. OP. BANK LTD. & SCIENCE CITY
Beneficiary Bank IFSC Code AMCB0660013 Account Type : Resident ✔ / Non Resident
Amount (in figures) to be credited 200,000.00
Amount (in words) to be credited Two Lakhs only

My / Our Details (Remitter)

Remitter (Applicant) Name JAYANT SOMABHAI PATEL
Remitter Account Number 00061000025412
Cash Deposited (Non HDFC Bank Customer)
Mobile / Phone Number of Remitter ( Mandatory) +91 9898597713 E-Mail Id:
Address of the Remitter (Mandatory for Non – HDFC
Bank Customer)
Remarks
Terms & Conditions
* I
/ We hereby authorize HDFC Bank Ltd. to carry out the RTGS / NEFT ✔ transaction as per details mentioned above. (Tick  the appropriate Box)
* I
/ We hereby agree that the aforesaid details including the IFSC code and the beneficiary account are correct.
* I
/ We further acknowledge that HDFC Bank accepts no liability for any consequences arising out of erroneous details provided by me/us.
* I
/ We agree that the credit will be affected solely on the beneficiary account number information and beneficiary name particulars will not be used for the same.
* I
/ We authorize the bank to debit my / our account with the charges plus taxes as applicable for this transaction.
* I
/ We agree that requests submitted after the cut off time will be sent in next batch or next working day as applicable.
* I
/ We hereby agree & understand that the RTGS / NEFT request is subject to the RBI regulations and guidelines governing the same.
* I
/ We also understand that the remitting Bank shall not be liable for any loss of damage arising or resulting from delay in transmission delivery or non-delivery of Electronic
message or any mistake, omission, or error in transmission or delivery thereof or in deciphering the message from any cause whatsoever or from its misinterpretation
received or the action of the destination Bank or any act or even beyond control.
* I/We agree that incase of NEFT Transaction if we do not have an account with the bank, we will produce Original identification proof while giving the request. In case I/We
submit form 60, we will also submit the address proof.
* In case the RTGS and NEFT option is not ticked by us, I / We authorize you to execute the transaction less than Rupees Two Lacs through NEFT and greater than or
equal to Rupees Two Lacs through RTGS and debit the charges as applicable.

Signature of
Authorized
Signatory
____________________ ____________________ ____________________
1st Signatory 2nd Signatory 3rd Signatory
Please affix stamp wherever applicable
Branch Use Only
Transaction Reference Number

Transaction Inputted by
Employee Code Signature

Transaction Authorized by
Employee Code Signature
Transaction Authorized by (2nd level)
(for amount > Rs. 5 lacs) Employee Code Signature
KYC documentation done by (only for Non-HDFC
Bank Customers) Employee Code Signature Branch Stamp, Date & Sign
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Customer Acknowledgement
Received application for RTGS / NEFT 200000.00
for an amount of Rs. ____________________ 000014
vide cash / cheque number ________________ to be credited to Account
066013001002741
Number ________________________________ THE AHMEDABAD MERCANTILE CO. OP. BANK LTD. & SCIENCE CITY
of _______________________________ AMCB0660013
Bank with IFSC Code____________________________. Customers will be
guided by the Terms and Conditions mentioned in the form. HDFC Bank will accept no liability for any consequences arising out of erroneous details provided by the Customer.

07/03/2024
Date __________________ Time_______________ _Branch Stamp & Sign __
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