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UTILITY CODE - 5609115: Electronic Clearing Service (Debit Clearing) Mandate Form

This document is a mandate form authorizing electronic debit payments from a customer's bank account for loan EMIs with HDFC Bank. It provides the customer's name, loan account number, contact details, maximum debit amount of the EMI, effective date of the 10th or 25th of each month, bank account details including name, branch, MICR code, account type and number. The customer authorizes the bank to debit the EMI amount from the specified account and takes responsibility as a participant in the debit clearing scheme. A cancelled cheque from the account must be attached.

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Bharath Reddy Vummannagari
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© © All Rights Reserved
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92 views

UTILITY CODE - 5609115: Electronic Clearing Service (Debit Clearing) Mandate Form

This document is a mandate form authorizing electronic debit payments from a customer's bank account for loan EMIs with HDFC Bank. It provides the customer's name, loan account number, contact details, maximum debit amount of the EMI, effective date of the 10th or 25th of each month, bank account details including name, branch, MICR code, account type and number. The customer authorizes the bank to debit the EMI amount from the specified account and takes responsibility as a participant in the debit clearing scheme. A cancelled cheque from the account must be attached.

Uploaded by

Bharath Reddy Vummannagari
Copyright
© © All Rights Reserved
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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UTILITY CODE -5609115

ELECTRONIC CLEARING SERVICE (DEBIT CLEARING) MANDATE FORM


CUSTOMERS OPTION TO MAKE PAYMENTS THROUGH DEBIT CLEARING
SCHEME NAME

EMI PAYMENT HDFC LTD

PERIODICITY OF PAYMENT

MONTHLY

1. CUSTOMERS NAME

2. LOAN ACCOUNT NUMBER

3. TELEPHONE NO. RES / OFF

.. MOBILE : .

4. EMAIL ID

5. MAXIMUM AMOUNT

EMI

6. DATE OF EFFECT

..

(10th or 25th of the Month)

(DATE)

(MTH)

(YEAR)

7. PARTICULARS OF THE BANK ACCOUNT


BANK NAME
BRANCH NAME

:
:

MICR CODE
ACCOUNT TYPE

Savings (10) / Current (11) / Cash Credit (13)

LEDGER NO. / LEDGER FOLIO:

ACCOUNT NUMBER

I hereby declare that the particulars given above are correct and complete. If the
transaction is delayed or not effected at all for reasons of Incomplete or incorrect
information, I would not hold the user institution responsible, I hereby authorise my Bank
(as mentioned above) to debit my above mentioned account with the amount of installment
& I agree to discharge the responsibility expected of me as a participant under the scheme.
Date : .

(.)
Signature of the Customer
Certified that the particulars furnished above are correct as per our records.
Banks Stamp :
Date
:

(.)
Signature of Bank Official

NOTE : PLEASE ATTATCH A CANCELLED CHEQUE

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