“Sri Godiji Parsvanathaya Namaha”

“Sri Ganeshaya Namaha”

Please
affix
NEFT REQUEST FORM Passport Size
Photo

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. Office:
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.