NEFT REQUEST FORM

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					                                                                   “Sri Godiji Parsvanathaya Namaha”
                                                                         “Sri Ganeshaya Namaha”

                                                                                                                                                   Please
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                                        NEFT REQUEST FORM                                                                                       Passport Size
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Kindly fill the details in CAPITAL letters
  Track ID : _______________________________________________________________
  Name : ________________________________________________________________
  Father / Husband Name : __________________________________________________
  Mother Name : __________________________________________________________
  Add 1 : ________________________________________________________________
  Add 2 : ________________________________________________________________
  Add 3 : ________________________________________________________________
  City : ___________________ State: _______________________ Pin: ______________
  Phone No (Code) : (Off) ________________________ (Res) ______________________
  Mobile : ________________________________________________________________
  email : _________________________________________________________________
  Date of Birth : ___________________________________________________________
  Bank Name : ____________________________________________________________
  Branch : _______________________________________________________________
  Current / Saving A/C No : __________________________________________________
  PAN No (Permanent Account No.) : _________________________________________
  IFS Code : ______________________________________________________________
  Preferrable mode of despatch of documents
  (Whichever is applicable)
       Professional Courier         Speed Post       DTDC Courier

  Signature : ______________________________________ Date : __________________
                                                                     Regd. O ce:
                                                    RMP INFOTEC PRIVATE LIMITED
                                                                 (CIN-U72200 TN2001 PTC047636)
                                       MEMBERS - FICCI (FEDERATION OF INDIAN CHAMBERS OF COMMERCE AND INDUSTRY)
                 WTCA (WORLD TRADE CENTRE ASSOCIATION INC. NEWYORK) TIN No. 33661502016 CST NO. 813258 DT. 14.12.01 Area Code - 076
        F1, 1st Floor, Apollo Dubai Plaza, 100, Mahalingapuram Main Road, Chennai - 600 034. Phone: +91 44 23463504 / 23463505 Fax: +91 44 42138434
                                                    eMail: customercare@rmpinfotec.biz URL: www.rmpinfotec.biz

Proof of Documents: Kindly provide your Bank Passbook copy with Address Proof and a Cancelled
     Cheque along with this letter to take effect of this Funds Transfer system immediately.