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Bank Mandate Form

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Nikhil Bisui
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389 views

Bank Mandate Form

Uploaded by

Nikhil Bisui
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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MANDATE FORM

ELECTRONIC CLEARING SERVICE (CREDIT CLEARING)/REAL TIME GROSS SETTLEMENT (RTGS) FACILITY
FOR RECEIVING PAYMENTS

A. DETAIL OF ACCOUNT HOLDER:-

NAME OF ACCOUNT HOLDER

COMPLETE CONTACT ADDRESS

TELEPHONE NUMBER/FAX/EMAIL

B. BANK ACCOUNT DETAILS:-


BANK NAME

BRANCH NAME WITH COMPLETE


ADDRESS
TELEPHONE NUMBER AND ADDRESS

WHETHER THE BRANCH IS


COMPUTERISED
WHETHER THE BRANCH IS RTGS ENABLED
? IF YES, THEN WHAT IS THE BRANCH’S
IFSC CODE
IS THE BRANCH ALSO NEFT ENABLED

TYPE OF BANK ACCOUNT


(SB/CURRENT/CASH CREDIT)
COMPLETE BANK ACCOUNT NUMBER
(LATEST)
MICR CODE OF BANK
DATE 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 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.

(Bank Stamp) (……………………………………………)


Signature of Banker

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.

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