Date : ______________________________
To,
The Branch Manager,
ICICI Bank Limited
______________________________ Branch
Dear Sir / Madam,
I request you to debit my account no.: ____________________________________________________________ for
Rs.: __________________________ ( Rupees _____________________________________________________________ )
And
1 credit account no.: ________________________________ of _________________________________
OR
2 Issue a banker s cheque / demand draft payable at
______________________________ Branch for Rs.: _____________________________ in favour of
______________________________________________________________________________________
Thanking you,
Yours faithfully,
SIGNATURE :
CUSTOMER NAME :