Bank Mandate Form
Bank Mandate Form
ELECTRONIC CLEARING SERVICE (CREDIT CLEARING)/REAL TIME GROSS SETTLEMENT (RTGS) FACILITY
FOR RECEIVING PAYMENTS
TELEPHONE NUMBER/FAX/EMAIL
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 that user institution
responsible. I have read the option invitation letter and agree to discharge responsibility expected of me as a
participant under the Scheme.
(……………………………………………)
Signature of Customer
Date:-
Certify that the particulars furnished above are correct as per our records.
Date:-
1. Please attach a photocopy of cheque along with the verification obtained from the bank.
2. In case your Bank Branch is presently not “RTGS”, then upon its up gradation to “RTGS Enabled” branch,
please submit the information again in the above Performa to the Department at earliest.