Authorization for payment of refund amount directly to Bank Account

I.E.C. No. _______________ PAN No. _________________.


M/s ______________________________

Address: __________________________




E-mail address:

Bank Account No.: __________________


Bank Name: ______________________


Bank Address: ______________________


11 digit alphanumeric IFS Code : ________________


I declare that the above particulars are correct. I authorize payment of refund amount for my refund claims filed at ______________________ Custom House to my above mentioned Bank Account through NEFT / RTGS after deduction of Bank’s service charges at the rate of 0.09% and applicable NEFT / RTGS charges as per RBI guidelines.


Name of the Authorised signatory /
Representative of the Importer

Signature :



Certified that the above details are correct.

Signature of Bank Branch Manager along with the official Seal

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