Kotak logo
Kotak Mahindra Bank

RTGS/NEFT Application Form

RTGS NEFT (Select RTGS or NEFT as remittance type)
Kotak Mahindra Bank, Date :
Branch
Please debit my account number vide Cheque# and remit through NEFT/RTGS
a sum of Rs. (Rupees in words )
as per details given below. Please also debit the said account with your service
charges and Govt. taxes as applicable for this remittance.
Purpose Code
(Mandatory for RTGS Transactions. Please select from table below)
Beneficiary
Details		 Beneficiary Account Type Current Savings NRE OVERDRAFT (OD) CASH CREDIT (CC) CREDIT CARD LOAN Others \n
Full Name of Beneficiary :
Beneficiary A/c Number
Confirm Beneficiary A/c Number
IFSC Code
Bank
Branch
Beneficiary LEI number*
(* mandatory only if the amount is Rs. 50 Crore and above)

I/We hereby confirm that I/We have read and understood the terms and conditions mentioned overleaf.

Signature/s: (Authorised Signatory/Account Holder)
Name
For Bank Use Only    1. Sign & Employee Code (Maker) : 2. Sign & Employee Code (Checker) :
3. Date & Time : 4. UTR #

I/We hereby confirm the correctness of the details like beneficiary name, *account number, IFSC code of the beneficiary Bank Branch. #Legal Entity Identifier (LEI) of remitter and/or beneficiary are valid & correct. I/We am/are aware that the Bank will get the valid discharge if the amount is credited to the beneficiary account number requested in RTGS/NEFT application and the Bank shall not assume any liability arising out of incorrect IFSC code, mismatch in the beneficiary name including but not limited to mismatch in the spelling.

I/We declare that I/we am/are authorized to request the Kotak Mahindra Bank (herein after referred to as Bank) for RTGS/NEFT facility and all the person authorized to operate the above mentioned accounts are also authorized, as per the present mode of operation, to present the RTGS/NEFT fund transfer application form to Bank. I/We undertake to keep Bank informed of any changes in the mode of operation of any of the above accounts.

Purpose Code:
CASHCash Management TransferINTEInterestSUPPSupplier Payment
CORTTrade SettlementLOANLoanTAXSTax Payment
DIVIDividendPENSPensionTRADTrade
KMBL-112/ATM-03
Kotak Mahindra Bank Ltd. CIN L65110MH1985PLC038137, Registered Office: 27 BKC, C 27, G Block, Bandra Kurla Complex, Bandra (E), Mumbai 400051

Customer Acknowledgement

Branch: Date :
We acknowledge the receipt of NEFT/RTGS instructions for an amount of Rs. vide cheque number
to be credited to the Account number of Bank.
UTR# Bank Seal
Bank Officials Signature With Date & Time of Request