EFT Form Template

Sample electronic funds transfer letter / authorization form to bank for payment

EFT-RE

REV.F/13:14:000 EFT REQUEST FORM

REQUEST FOR TRANSFER OF MONEY

REMITTER BRANCH BENEFICIARY BANK & BRANCH BANK CODE (9 DIGIT MICR CODE) (as shown in Cheque Book) BENEFICIARY NAME BENEFICIARY ACCOUNT NO. ACCOUNT TYPE (2 DIGIT CODE) (as shown in Cheque Book) REMITTER NAME & A/C NO. AMOUNT

: : : : : : : :

STATE BANK OF INDIA, MUMBAI ICICI BANK 14/1 NARIMAN POINT MUMBAI  – 458 545 -------------- ROCKAT SALES LTD CC---------------- 13 ABC CORPORATION LTD ---------------------- RS. (RUPEES     LACS ONLY)

PLEASE DEBIT OUR ACCOUNT A/C NO. -------------AND EFFECT THE TRANSFER.

ABC CORPORATION LTD AUTHORISED SIGNATORY

DATE : 25.05.13

-------------------------- FOR OFFICE USE ONLY -----------------------------------------

EFT EFFECTED ON :

AUTHORISED SIGNATORY