Date:

To,
Paytm Payments Bank Limited
A-80, Ground Floor,
Sector-2, Noida-201301.

Sub – Reversal request of funds due to wrong UPI transfer

Dear Sir,

This has reference to below mentioned funds which have been transferred through UPI.
I, ________________________<name>, certify that I entered the wrong account number/UPI VPA while doing the transaction and it has
resulted in transfer of funds to another account (unintended beneficiary). The intended beneficiary of the transaction
is____________________<actual beneficiary name>, having an account no._______________________<correct account number>
AND/OR _____________________________<correct VPA> held with_______________________________<bank name>.

*Mandatory to provide correct 12-digit RRN & Date of transaction.

SECTION – A : Remitter's Particulars

Case Sl. PPB A/c No. PPB A/c Name
No.
1.

SECTION – B : Wrong / Unintended Beneficiary Particulars

Case A/c No. VPA IFSC Beneficiary Bank Amount Txn No. Txn
Sl.No. (if available / (if available / Name Transferred (RRN) Date
applicable applicable)
1
.

SECTION – C : Correct / Intended Beneficiary Particulars

Case A/c No. VPA IFSC Beneficiary Bank Name Amount
Sl.No. (if available / (if available / applicable) Transferred
applicable
1
.

I request Paytm Payments Bank Ltd to take up this matter with bank for reversal of the above transaction and credit back in the
Paytm Payments Bank Ltd account on best effort basis.

I hereby undertake and agree to indemnify and shall keep Paytm Payments Bank Ltd indemnified and harmless, against all claims
demands, actions legal proceedings made against Paytm Payments Bank Ltd by any person, individual, bank, entity for the stated
transaction and losses, costs (including legal fees and expenses), damages, consequences etc. of whatsoever nature if any, suffered
and / or incurred by Paytm Payments Bank Ltd with respect to such refund of aforementioned transaction amounts.

I also undertake that in the event of any dispute on the claim of such transaction and/or inaccuracy, mis-match of any details
submitted by the undersigned, Paytm Payments Bank Ltd is authorized to block my wallet / account till the time the same is settled.

Thanking you, Yours

Faithfully,

Name & Signature: Regd.

Mobile number: Regd. E-
Mail ID:
Aadhar/Pan Card/ Voter ID/ Driving license/ Passport