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 :

Date:

Place:

Certified that the above details are correct.

Signature of Bank Branch Manager along with the official Seal