Karnataka Bank Ltd.

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Karnataka Bank Ltd. Date:______________ Regd. & Head Office: Mangalore Date: _________________
Branch _______________
Branch _____________________
Money Quick (RTGS) - Customer’s Counterfoil:
MONEY QUICK (RTGS) APPLICATION FORM
Received application for details furnished below:
Details of Applicant : Details of Applicant :
A/c Number :_________________________________
Name: ______________________________________ A/c Number :________________________________________________________________
Amount ` :__________ Amount in words: Rs._____ Name: _____________________________________________________________________
Charges `: __________ ______________________
Zero only
Total `: ____________
0 __________________only Amount `: ______________________ Amount in words: Rupees ____________________
Zero only
Cheque Num:_____________ Date:_____________ Charges `:_______________________ __________________________________________
Details of Beneficiary:
Bank: _____________________________________ Total `:_________________________
0 _____________________________________ Only.
Branch: ____________________________________
IFSC (11 Characters):_________________________ Email/Mobile:________________________________________________________________
A/c num: ___________________________________ Cheque Num:______________________ Date:______________________________________
Name: _____________________________________
Details of Beneficiary:
For office use:
Bank: _________________________ Branch: _____________________________________
UTR: ______________________________________ IFSC (11 Characters):_________________________________________________________
A/c num: ___________________________________________________________________
Name: _____________________________________________________________________

Authorised Signatory Please remit the amount as per the aforesaid details by debiting my/our account for the amount of remittance plus
------------------------------------------------------------------ your charges. I/We declare that I/we am/are authorised to operate the above mentioned sender account as per
present mode of operation. I/We agree to abide by the terms & conditions given overleaf and bound to the Rules
Note: The Bank shall not be liable for any loss or damage arising and Regulations of RTGS facility as amended from time to time and as published in www.karnatakabank.com.
or resulting from delay in transmission / delivery or non-delivery I/We understand that the above details mentioned in the application are correct. I/We are aware that the RTGS
of Electronic message or any mistake, omission, or error in payment will be made based on the IFSC and the BENEFICIARY A/C NUMBER and the Bank will in no way be
transmission or delivery thereof or in deciphering the message liable due to the incorrect details furnished.
from any cause whatsoever or from its misinterpretation received
or the action of the destination bank or any other act even beyond
For office use:
control. The terms & conditions given overleaf and detailed terms SD number:__________ UTR: ________________________
& conditions are published in www.karnatakabank.com.
PTO
Entered By Verified by Signature of Applicant/s

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