Transcription of Mandate Form for Electronic Transfer of Claim …
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Example: bankruptcy
Mandate Form for Electronic Transfer of Claim …
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). I/we have read the declarations / conditions mentioned overleaf. Place: _____Date: _____ (Beneficiary's Signature)_____. MANDATORY REQUIREMENT. PLEASE ATTACH HERE.
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 …
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