CNSTRACK – ICICI RTGS/NEFT Form

ICICI BANK

REAL TIME GROSS SETTLEMENT/NATIONAL ELECTRONIC FUNDS TRANSFER

(RTGS / NEFT) APPLICATION FORM

(To be filled by the Remitter)

BRANCH NAME:

DATE:

APPLICANT (REMITTER) DETAILS

NAME *

ACCOUNT NO. *

MOBILE NO. *

BENEFICIARY DETAILS

NAME *

ACCOUNT NO. *

BANK NAME *

BRANCH *

IFSC CODE *

AMOUNT (₹) *

BANK CHARGES (₹) *

TOTAL AMOUNT (₹)

CHEQUE NO. *

CHEQUE DATE *

AMOUNT IN WORDS

Remit the amount as per above details by RTGS/NEFT, by debiting my / our account for the amount of remittance plus your charges. We agree to abide by the term and conditions for the transfer.

FOR BANK USE ONLY

BRANCH NAME

TRANSACTION ID

AUTHORIZED BY

PROCESSED DATE

TERMS AND CONDITIONS:

1. I/WE AGREE TO THE TERMS AND CONDITIONS GOVERNING THE RTGS/NEFT FACILITY.

2. THE BANK IS NOT RESPONSIBLE FOR DELAYS IN CREDITING THE BENEFICIARY'S ACCOUNT.

3. I/WE CONFIRM THAT ALL PROVIDED DETAILS ARE ACCURATE.

CUSTOMER SIGNATURE

BANK OFFICER SIGNATURE