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    A - NEFT Form

    Uploaded by

    Archana

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd

    A - NEFT Form

    Uploaded by

    Archana
    12 views1 page

    Original Title

    A_NEFT form

    Copyright

    © © All Rights Reserved

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    PDF or read online from Scribd

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    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Download as pdf
    12 views1 page

    A - NEFT Form

    Uploaded by

    Archana

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Download as pdf
    of 1
    landate Form for Electronic Transfor of Claim. To [ce Code & Name ] Bajaj Allianz General Insurance Company Ltd rack Number, Partner ID (ro be ned by omee MS sa vay, a = Secret) Sek) [| aes ea ee] Ss Shvi/ Smt Kum / Mis YS ANIMA ARCHANA {As opposes in your Sank oun Full Address: WA0¥SE N03-143) SC COLONY, NEPR GRAM PRC HATATT UZURABADMANDAL SLRSAPPULEPIN Code: 5054 6 @ ontact / Mobile No cue, 436424089 emai, Karcrinn © delottte . Co 7 Bark’Neme: STALE Bane pf TNDIA | 6)- Bi iC UZLORB RRO | Branch Name & Address: Sate sink Bi aRty nur eee HU2URAB AD, KARIPINAGAR = 0546 Branch Tel No & Contact No: 8429 262023 BancirsconstenerT | STR [Lm o lo |6)5 | +1 [6 | Branch MICR Code sie le lo fo [2 lo [3 16 (Spertomzccoy | TAWS KAN AMA ARCHANA ‘Account Type 7] savings [__ [estrone ash Great Account No | ee) | liwe have read the declarations / conditions mentioned ovetlea, Prace: KARIMMAGHR pate; \3]01|202% (Beneficiary Signature) MANDATORY REQUIREME: | PLEASE ATTACH HERE for ensuring accuracy of name ofthe bank, branch name, Account number and ‘ofthe payee isnot printed on the chaque lea, please attach copy of th tree none {nav veri th documents atachad with the mance and contin Wa hese documents conecl belo ‘Partner Name mentioned in the mandate. (To be verified by superior ) ly belong to the Partner ID & Employee Code 6°24 Employee Nam

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