DD/PO ISSUANCE FORM

Branch:________________________________ Date: D D M M Y Y Y Y

No. Beneficiary Place Amount in Rupees Total

1.
2.
3.
4.

Total Amount (in words) Rupees_________________________________________________________________________________

_______________________________________________________________________________________________________________________________________________

Debit Authorisation:
I hereby authorise the Bank to debit my account___________________________________
Applicant / Account Holder's
vide cheque number________________________ for issuance of DDs/POs as given above. Signature / Stamp

I understand that the associated charges will be debited from my account.

For Cash DD/PO's Only (Total amount of cash DD/PO's including commission should be less than ` 50,000).
Purchaser’s Name
Purchaser’s Add.
Identity Proof
KYC Proofs taken
Address Proof

Handover Authorisation: Kindly handover the DD/PO to the bearer of this request, the signature of whom is attested below:

For Ofcial Use Only *Kindly furnish the details of notes

DD/PO Nos. Issued Notes Nos Amount `

1. 3. 2000
500
2. 4.
200
100
50
Branch Official’s Signature Bearer’s Signature 20
10
5
Total

CUSTOMER ACKNOWLEDGEMENT
Branch:________________________________ Date: D D M M Y Y Y Y

Received From________________________________________________ Amount of DD/PO `

____________________________________________________________ Commission (for cash) `
Towards DD/PO on (Place)______________________________________ Total `
_____________________________________________________________
Total Amount (in word) Rupees____________________
favoring______________________________________________________
______________________________________________

Applicant / Account Holder's

Signature/Stamp Authorised Officer