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Ecs - Donations

This document is a mandate form for electronic clearing service (ECS) debit authorization. It contains information about the customer, including their name, address, bank details, and ECS debit scheme details. The customer is authorizing their bank to debit amounts from their account and make payments to Atharavu Iyakka Arakkattalai through ECS clearing as per the specified periodicity and number of installments. The customer confirms the information provided is correct and acknowledges their responsibilities as a participant in the scheme. The form requires the customer and bank signatures to certify the details.

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10K views

Ecs - Donations

This document is a mandate form for electronic clearing service (ECS) debit authorization. It contains information about the customer, including their name, address, bank details, and ECS debit scheme details. The customer is authorizing their bank to debit amounts from their account and make payments to Atharavu Iyakka Arakkattalai through ECS clearing as per the specified periodicity and number of installments. The customer confirms the information provided is correct and acknowledges their responsibilities as a participant in the scheme. The form requires the customer and bank signatures to certify the details.

Uploaded by

api-274799987
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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APPENDIX VIII

FORM NO.E-5
MANDATE FORM
ELECTRONIC CLEARING SERVICE (DEBIT CLEARING)

Copy to Organization
Atharavu Iyakka Arakkattalai, No 21 Nehru street Extn,
Arumaikkaranthottam, 15Velampalayam .po ,Tirupur.dt
Tamilnadu India. pin code;641652. cell 98423 41607, 99653 49643

MEMBERS (CUSTOMERS) HOME ADDRESS


Name: _____________________________________________________________________________________________________________________________
Address ____________________________________________________________________________________________________________________________
City ____________________________________________STATE:___________________________________________ MOB: ________________________________
TO

The Manager
MEMBERS BANK DETAILS
(Bank Name:____________________________________________________ Branch Name): ________________________________________________________
(Address): ____________________________________________________________________________________________________________________________
City: _____________________________________________________________ State:_____________________________________________________________
I __________________________________________________________ hereby authorize you to debit from my account for making payment to
Atharavu Iyakka Arakkattalai through ECS (Debit) clearing as per the details given as under.
A.

9-DIGIT CODE NUMBER of the Bank & Branch (Appearing on the MICR Cheque issued by the Bank):

B.

ACCOUNT TYPE Current account-CC/OD):________________________________________

C.

ACCOUNT NUMBER

NAME OF THE SCHEME

Date of effect

Periodicity
(monthly/Quarterly/
Half Yearly / Yearly

Amount of
Installment

No. of Installments/valid upto (Ex:60


months/31-7-2015)

Atharavu Iyakka
Arakkattalai Donation

D.

Date of effect: ________________________________________

I hereby declare that the particulars given above are correct and complete. If the transaction is delayed or not effected all for reasons of incomplete or incorrect
information, I would not hold the user institution responsible. I have read the option invitation letter and agree to discharge the responsibility expected me as a
participant under the scheme.
Date: ________________________________________
Place: ________________________________________
-----------------------------------------------------------------Signature of the customer
For Official Purpose

We certify that the particulars furnished above are correct as per our records.

Bank Stamp/Date

(Signature of the authorized official from the bank)

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