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Ecs E-5

This document is a model mandate form for customers who wish to receive payments through electronic clearing services. It requests the following information: 1) The name of the payment scheme and payment periodicity. 2) The customer's name and bank account details including name, branch, MICR and account numbers. 3) A blank cancelled cheque or deposit slip for verification purposes. The customer agrees that the information provided is correct and won't hold the payment institution responsible for delays or failures due to incorrect or incomplete information. The customer also agrees to their responsibilities under the payment scheme. The bank certifies the account details as correct.

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315 views

Ecs E-5

This document is a model mandate form for customers who wish to receive payments through electronic clearing services. It requests the following information: 1) The name of the payment scheme and payment periodicity. 2) The customer's name and bank account details including name, branch, MICR and account numbers. 3) A blank cancelled cheque or deposit slip for verification purposes. The customer agrees that the information provided is correct and won't hold the payment institution responsible for delays or failures due to incorrect or incomplete information. The customer also agrees to their responsibilities under the payment scheme. The bank certifies the account details as correct.

Uploaded by

binchac
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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FORM NO.

E-5 Appendix VIII Electronic Clearing Service (Credit Clearing) Model Mandate Form (Investor/customers option to receive payments through Credit Clearing Mechanism) Name of the Scheme and the periodicity of payment No. 1) Investor/customers name: 2) Particulars of Bank account A B Name of the Bank :

Name of the branch : Address Telephone No. : :

9-Digit code number of the bank and branch appearing on the MICR cheque issued by the bank:

Type of the account (S.B., Current or Cash Credit ) with code (10/11/13)

E F

Ledger and Ledger folio number: Account number (as appearing on the cheque book)

(In lieu of the bank certificate to be obtained as under, please attach a blank cancelled cheque or photocopy of a cheque or front page of your savings bank passbook issued by your bank for verification of the above particulars) Date of effect: 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 have read the option invitation letter and agree to discharge the responsibility expected of me as a participant under the scheme. (.....................................) Signature of the Investor/Customer Date Certified that the particulars furnished above are correct as per our records. Banks Stamp Date: (.................................) Signature of the authorised official of the Bank

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