ELECTRONIC PAYMENT REQUEST FORMAT (NEFT/RTGS)

(TO BE FILLED IN CAPITAL LETTERS)

All Fields are Mandatory

EIP VENDOR CODE (Refer the PO to

know your vendor code)

Name of the Organization & …………………………………………………………

Complete postal address with
PIN Code & E-mail id. …………………………………………………………
…………………………………………………………
Pan Number Details

(please attach a copy of pan card)

Contact No:
STD Code

Phone No

Type of Organization Public Limited Private Limited LLP (Limited Liability

Partnership)

Partnership Firm (Attach Partnership Deed) Proprietary Others

If it is a Partnership Firm, please ensure that all the Partners sign in this Format .

Bank Name: ……………………………………………………………………………………….

Full Bank A/C No:

(Should not have any prefix or suffix with alphabets, words, hyphen, bar, coma or full stop.)

Type of Account Current Cash Credit Others

Please tick in the box Specify

Bank Branch Code:

(Nine digits MICR code
Appearing next to cheque no.) (Please attach a copy of cancelled or blank cheque)

Bank Address: …………………………………………………………………

(Complete postal address)
…………………………………………………………………
Pin:

Bank Phone No:

If your Bank’s branch is having Electronic payment facility (NEFT & RTGS), please interact with
your banker and furnish IFS Code in the box given below. This is the easiest, reliable & fastest mode
of payment and the fund will be directly credited to your account. (RTGS takes 2-3 hours, NEFT same
day)

IFS Code (Eleven digits)

We hereby accept to receive our payment through Electronic Fund Transfer system. We shall intimate to you
immediately in case of any change in the above particulars.
(Name & Signature by Authorised Signatory with Seal)

Place:
Date:
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Please contact us at myservice@lntecc.com for any further clarifications.
Courier the Original filled EFT format & cancelled Cheque to below mentioned address.
Larsen & Toubro Limited, SSC Accounts Payable,ECC Division,HQ Accounts,
Mount Poonamallee Road,Manapakam,Chennai-600089.
Ph : 044-22526616/17/62/71/72/73/74/75/78. Fax: 044-22526059.