BANK OF BARODA BANK OF BARODA
ANNEXURE – II PAYING – IN – SLIP FOR NEFT / RTGS Form No. 404
Branch_______________________ Branch___________________ Date______________________ Time of Receipt ____________
Date ________________________ (FOR RTGS – AMOUNT MUST BE FOR ` 2 LACS OR MORE )
COUNTER FOI L Application for Electronic Funds Transfer to a customer of another Bank through RTGS/NEFT. (to be filled in by customer)
Sender’s a/c no.
Sender’s a/c no of base branch
Name of a/c holder
Name of a/c holder (sender)
NEFT / RTGS:
NEFT / RTGS:
Favouring(payee) Name
Favouring/beneficiary (Name) ______________________________________________________________________________
Bank:
Receiving Bank Name:
Branch:
Receiving Branch Name:
IFS Code:
Receiving Branch IFS Code:
Beneficiary a/c no:
Beneficiary a/c no:
Beneficiary a/c type:
Beneficiary a/c type: (SB/CA/OD/CC/NRE/Credit Card)/Remittance to Indo Nepal
Message for beneficiary (applicable for RTGS only)
Amount `
Amount `
Exchange `
Exchange `
Total amount `
Total amount `
Total amount in words
Total amount in words
Beneficiary a/c no:
( to be written 2nd time as per RBI guidelines)
I /We request you to make the above remittance. It is being understood that the remittance is to be sent at my/our own risk and
Signature of Customer my/our responsibility and on the distinct understanding that no liability whatsoever is to attach to the Bank for any loss or
Tel/Mob No.__________________ damage arising or resulting from delay in transmission, delivery or non delivery of the message or for any mistake, exchange or
PAN ________________________ error in transmission or delivery thereof or in deciphering the message from whatsoever cause or from its misinterpretation when
received or from failure to properly identity the persons name. I/We also hereby undertake to refund to bank any over remittance,
which is made as per RBI RTGS/NEFT scheme.
Bank’s Seal Please remit the amount as per above details by (i) debiting my/our SB/CA/OD/CC/NRE/ a/c No._________________________ with
________________________ Branch (ii) I/We herewith tender cheque No ______________ drawn on our a/c towards its cost
including Bank charge.
Sign. of Clerk/Cashier/Teller Signature of Customer Sign. of operator sign. of officer Sign. of officer
Tel/Mob No._________________________. (who created mesg.) (who authorized) ( who verified)
PAN _______________________________.