8/8/2019 Epayment Form -New

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THIS FORMAT IS TO BE USED IF YOU OPT TO RECEIVE EPAYMENTS

Date:-To,Reliance Retail LtdMaker Chamber IV, 9th Floor222, Nariman Point,Mumbai 400 021.

Dear Sir,

Sub: EPayments

I/We request and authorise you to effect E Payment to my/our Bank account as per the detailsgiven below:

Vendor code :

Title of Account in the Bank :

Bank Account Number :

Name & address of Bank :

E mail address(Where email will be sent when epayment take place) : (Please mention the email address of your company/organisation)

Permanent Account Number :

Name of the Authorised Signatory : (Please mention here name of person from your organization signing this letter.)

Contact Persons name : (Please mention here the name of a person in your company/organization)

Thanking you,

For

(Authorised Signatory) Banks Verification

PTO

8/8/2019 Epayment Form -New

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(Please fill this after you obtain this from the branch where you have your account)

(Please mention here the name of a person in your company/organization)

(Please enclose a Xerox a copy of a cheque. This cheque should not be a payable at par cheque)

THIS FORMAT IS TO BE USED IF YOU OPT TO RECEIVE EPAYMENTS THROUGH YOUREXISTING ACCOUNT WITH RTGS / NEFT ENABLED BANK BRANCH

Date:To,

Reliance Retail LtdMaker Chamber IV, 9th Floor

222, Nariman Point,Mumbai 400 021.

Dear Sir,

Sub : EPayments vide RTGS / NEFT

I/We request and authorise you to effect Epayment to my/our Bank account as per the details given below:

Vendor code :

Title of Account in the Bank :

Account Type : (Please mention here whether account is savings or current or cash credit or overdraftor any other)

Bank Account Number:

Name & address of Bank :

Bank contact persons names : (Please mention here name of at least 2 persons)

Bank Tele Numbers with STD code :

Bank Branch MICR code:

Bank Branch IFSC code

:

Your Email address :

Name of the Authorised Signatory :

Contact Persons name :

I/We confirm that I/we will bear the charges, if any, levied by my/our bank for the credit of RTGS / NEFTamounts in our account.

Thanking you,

For

(Authorised Signatory)

We confirm that we are enabled for receiving RTGS / NEFT credits and we further confirm that the accountnumber of (Please mention here name of the account holder), the signature of the authorised signatory and the MICR andIFSC Code of our branch mentioned above are correct.

(Please mention the email address of your company/organization)

(Please mention here name of person from your organization signing this letter)

8/8/2019 Epayment Form -New

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(Managers/Officers signature underbank Stamp)

Banks Verification