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Basic Bank BEFTN & RTGS Form

This document is an application form for payment instruction for funds transfer via RTGS or BEFTN. It contains fields for the sender's account details, recipient's account details, transaction amount, purpose of transaction, and signatures. The sender authorizes the bank to debit the total amount from the sender's account and carry out the funds transfer as specified in the form. The bank has no liability for errors in the details provided. The form is provided in duplicate with one copy for the bank and one for the customer.

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mtuanlatoi9704
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1K views1 page

Basic Bank BEFTN & RTGS Form

This document is an application form for payment instruction for funds transfer via RTGS or BEFTN. It contains fields for the sender's account details, recipient's account details, transaction amount, purpose of transaction, and signatures. The sender authorizes the bank to debit the total amount from the sender's account and carry out the funds transfer as specified in the form. The bank has no liability for errors in the details provided. The form is provided in duplicate with one copy for the bank and one for the customer.

Uploaded by

mtuanlatoi9704
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Application Form for Payment Instruction Bank Copy

BD-RTGS BEFTN Date D D M M Y Y Y Y


Branch Name: Time H H M M

Sender's Details Receiver's Details


Account No.: Bank Name: Routing No.:
Account Name: Branch Name:
Currency: Amount: Account No.:
Amount in words: Account Name:
Address (Optional):
Purpose: Only for NBR Payment
Mobile No.: Customs Office Code (3 digit): Registration Year (4 digit):
Fee: VAT: Registration Number (Max 12 digit) :
Total Amount : Amount+Fee+VAT Declarant Code (Max 18 digit):
I / We hereby authorize BASIC Bank Limited to debit the total amount (amount + fee + VAT) from my/our above mentioned account to carry out the BD-RTGS /
BEFTN transaction as per details mentioned above. I / We acknowledge that BASIC Bank Limited has no liability for any consequences arising out of erroneous
details provided by me/us.

Signature(s) of the Sender(s)/Applicant Signature of the Receiving Officer of the Bank


(Please affix stamp wherever applicable)
Bank use only

Signature verified by Transaction done by (in KCBS) Transaction approved by (in KCBS)

Message prepared by (in RTGS/EFTN) Message Checked by (in RTGS/EFTN)

--------------------------------------------------------------------------------------------------------------------------------

Application Form for Payment Instruction Customer Copy


BD-RTGS BEFTN Date D D M M Y Y Y Y
Branch Name: Time H H M M

Sender's Details Receiver's Details


Account No.: Bank Name: Routing No.:
Account Name: Branch Name:
Currency: Amount: Account No.:
Amount in words: Account Name:
Address (Optional):
Purpose: Only for NBR Payment
Mobile No.: Customs Office Code (3 digit): Registration Year (4 digit):
Fee: VAT: Registration Number (Max 12 digit) :
Total Amount : Amount+Fee+VAT Declarant Code (Max 18 digit):
I / We hereby authorize BASIC Bank Limited to debit the total amount (amount + fee + VAT) from my/our above mentioned account to carry out the BD-RTGS /
BEFTN transaction as per details mentioned above. I / We acknowledge that BASIC Bank Limited has no liability for any consequences arising out of erroneous
details provided by me/us.

Signature(s) of the Sender(s)/Applicant Signature of the Receiving Officer of the Bank


(Please affix stamp wherever applicable)

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