NATIONAL ELECTRONIC FUNDS TRANSFER / REAL TIME GROSS SETTLEMENT

(To be filled in by the Applicant in BLOCK LETTERS) Customer's Copy Date -: Counterfoil

PART - I [Details of applicant/ remitter/ originator]

1. Remitter's Name: Mercurium 2. Bank Name/Branch: 3. Account Name: 4. Account No: 5. Type of Account: SB/ CA / CC:

Details of Beneficiary
Instructions to Bankers : PLEASE ENTER A/c No SEPARATELY FOR EACH CHALLAN AND GENERATE SEPARATE UTR No FOR EACH CHALLAN AS THE A/c No WILL BE DIFFERENT FOR EACH CHALLAN. Account No. AK44 4001 7413 0786 CITI0100000 Center / IFSC Code Bank Branch Beneficiary Name Type of A/c. Account Name Amount Rs. (a) Bank Charges Rs. (b) Total Amount Rs. (a+b)* Total In Words * If the Credit Amount is less than Total Amount, the payment reconciliation is liable for rejection. CITIBANK Bandra Kurla Complex Mumbai Central Coalfields Limited Current CCL

2004.00

(Includes Citi Appln Process Charges) (Local bank's charges extra.)

Instructions for bidders :

1) Do not re-use the challan for other tenders. 2) Do not alter/modify the Amount or any other printed matter in the challan. 3) Retain a copy of the counterfoil acknowledged by the Bank for your reference.

Customer's Signature Contact Phone No.

TENDER LINE DESCRIPTION CCL/SM(P)/CS/NUTBOLT/187/1213/11/ 01 supply of nuts and bolts of different size

For Bankers : UTR/Remittance No:

NATIONAL ELECTRONIC FUNDS TRANSFER / REAL TIME GROSS SETTLEMENT

(To be filled in by the Applicant in BLOCK LETTERS) Bank's Copy Date -:

PART - I [Details of applicant/ remitter/ originator]

1. Remitter's Name: 2. Bank Name/Branch: 3. Account Name: 4. Account No: 5. Type of Account: SB/ CA / CC: Mercurium

Details of Beneficiary
Instructions to Bankers : PLEASE ENTER A/c No SEPARATELY FOR EACH CHALLAN AND GENERATE SEPARATE UTR No FOR EACH CHALLAN AS THE A/c No WILL BE DIFFERENT FOR EACH CHALLAN. Account No. Center / IFSC Code Bank Branch Beneficiary Name Type of A/c. Account Name Amount Rs. (a) Bank Charges Rs. (b) Total Amount Rs. (a+b)* Total In Words Remit the amount as per the above details, by debiting my/our account for the amount of remittance plus your charges. Customer's Signature Contact Phone No. FOR BANK'S USE ONLY Rupees Debited Applicants A/c. Date of Transfer : Remittance No. Authorised Signatory

AK44 4001 7413 0786

CITI0100000 CITIBANK Bandra Kurla Complex Mumbai Central Coalfields Limited Current CCL

2004.00

(Includes Citi Appln Process Charges) (Local bank's charges extra.)