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Mandate Form for Electronic Transfer of Claim …

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Mandate Form for Electronic Transfer of Claim Payments To Office Code & Name : bajaj allianz general insurance company Ltd i-track Number : Partner ID (To be filled by Office): Full Name: Shri / Smt / Kum / M/s ________________________________________ ____. (As appears in your bank account). Full Address: ________________________________________ _____________________. ____________________________________PIN Code: ________________. Contact / Mobile No: __________ ___Email ID:_____________________________________ ___. Bank Name: Branch Name & Address: Branch Tel No & Contact No: Branch IFSC Code for NEFT. Branch MICR Code Name of the Account Holder : (As per Bank Account). Account Type Savings Current Cash Credit Account No. (as appearing in the cheque book).

Mandate Form for Electronic Transfer of Claim Payments To Bajaj Allianz General Insurance Company Ltd Office Code & Name : i-track Number : Partner ID (To be filled by …

  General, Company, Insurance, Bajaj allianz general insurance company, Bajaj, Allianz

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