STATE BANK OF INDIA ............................................ BRANCH ����������� ��� �������� ��� ����� ����� ����
A - Particulars of the Remitter 1 Name 2
Address
3
Date of Birth
4
Father’s / Mother’s Name
5
Mobile Number
B – Details of the Beneficiary 1 Name of the account holder with SBI 2
Savings Bank account number
3
Name of the Branch, where a/c is maintained Beneficiary’s mobile number
4
I have read and understood the rules and regulations of the SBI Green Remit Card and agree to abide by the terms and conditions relating to the conduct thereof as also any changes brought about therein from time to time. I am also aware that I can operate this card only for remitting the money to the pre-designated account as mentioned under B-2 above and certify that the particulars
given
above
are
correct
and
true.
I
also
submit
herewith
a
copy
of
………………………………………………… to establish my identity. I note to inform the bank, if there is any change in particulars quoted under ‘A’ above. I authorize the Bank to share the above information with any agency, if necessary. All remittances are subject to RBI guidelines from time to time under Cash Pay In . This card can be used for the purpose of remittance only at branches where Green Channel Counter / Bunch Note Acceptor facilities are available. Place: Date:
