NATIONAL ELECTRONIC FUNDS TRANSFER APPLICATION FORM To The IPP Cell PRE-PRINTED ADDRESS OF IPP CELL NECESSARY _________________________________ _________________________________ Sub : Option for NEFT Sir, I am interested to receive my annuity amount through NEFT. My details are as follows. (1) Policy Nos ___________________________________________________ ___________________________________________________ (2) Name & Address of Annuitant : ____________________________________ _________________________________________________________________ _________________________________________________________________ (3) Annuitant's Bank Name : ________________________________________ (4) Annuitant's Bank Address : _______________________________________ (5) Annuitant's Account Type : Savings/Current/Cash Credit/NRI _____________ (6) Annuitant's Account No. __________________________________________ (7) Annuitant's Branch IFS Code : _____________________________________ (8) Contact Mobile / Landline No. ______________________________________ (9) E-Mail Id : _____________________________________________________ (10) Do you want to receive SMS/E-mail alert on payment of annuity to your A/c : Yes / No ____________ Kindly transfer the amount payable to me under the aforestated policies as per details stated above. I have enclosed the following document to this effect. (Please appropriate item) A. Cancelled cheque leaf B. Photo copy of the page of Bank cheque/pass book containing details _____________________ Signature of the Annuitant Date :
