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ACH_FORM emandate

The document is an authorization form for TVS Credit Services Limited to debit a bank account for a fixed amount of Rupees 13,830 on a monthly basis, starting from March 3, 2025, until canceled. It includes customer details, bank information, and a confirmation of KYC verification for the loan application. The signatures of the primary account holder and other account holders are required for validation.

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0% found this document useful (0 votes)
30 views2 pages

ACH_FORM emandate

The document is an authorization form for TVS Credit Services Limited to debit a bank account for a fixed amount of Rupees 13,830 on a monthly basis, starting from March 3, 2025, until canceled. It includes customer details, bank information, and a confirmation of KYC verification for the loan application. The signatures of the primary account holder and other account holders are required for validation.

Uploaded by

ss244882
Copyright
© © All Rights Reserved
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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UMRN Date 2 6 0 1 2 0 2 5

Utility Code Create Modify Cancel


Sponsor Bank Code I/We hereby authorize TVS Credit Services Limited

to debit (tick ) SB/CA/CC/SB-NRE/SB-NRO/Other Bank a/c number 6 0 4 0 0 9 8 7 0 6 1


with Bank BANK OF MAHARASHTRA IFSC/MICR MA H B 0 0 0 1 0 1 1
an amount of Rupees THIRTEEN THOUSAND EIGHT HUNDRED AND THIRTY ONLY 13830 /-
DEBIT TYPE Fixed Amount Maximum Amount FREQUENCY Monthly Quarterly Half Yearly Yearly As & when presented

Customer ID 0038647086 Prospect No. 3047CD0440874


1.I agree for the debit of mandate processing charges by the bank whom I am authorizing to debit my account as per latest schedule of charges of the bank. 2.This is to confirm that the declaration
has been carefully read, understood & made by me/us. I am authorizing the User entity / Corporate to debit my account. 3.I have understood that I am authorized to cancel/amend this mandate by
appropriately communicating the cancellation / amendment request to the User entity / corporate or the bank where I have authorized the debit.

From 0 3 0 3 2 0 2 5
To 0 3 0 3 2 0 3 5
Or Until Cancelled
Signature Primary Account Holder Signature Account Holder Signature Account Holder
Phone No. 8307249500
1. MR MOHIT KUMAR 2. Name as in bank records 3. Name as in bank records

UMRN Date D D M M Y Y Y Y
Utility Code Create Modify Cancel
Sponsor Bank Code I/We hereby authorize TVS Credit Services Limited

to debit (tick ) SB/CA/CC/SB-NRE/SB-NRO/Other Bank a/c number

with Bank IFSC/MICR

an amount of Rupees
DEBIT TYPE Fixed Amount Maximum Amount FREQUENCY Monthly Quarterly Half Yearly Yearly As & when presented

Customer ID Prospect No.


1.I agree for the debit of mandate processing charges by the bank whom I am authorizing to debit my account as per latest schedule of charges of the bank. 2.This is to confirm that the declaration
has been carefully read, understood & made by me/us. I am authorizing the User entity / Corporate to debit my account. 3.I have understood that I am authorized to cancel/amend this mandate by
appropriately communicating the cancellation / amendment request to the User entity / corporate or the bank where I have authorized the debit.

From D D M M Y Y Y Y

To D D M M Y Y Y Y
Or Until Cancelled
Signature Primary Account Holder Signature Account Holder Signature Account Holder
Phone No.
1. Name as in bank records 2. Name as in bank records 3. Name as in bank records

UMRN Date D D M M Y Y Y Y
Utility Code Create Modify Cancel
Sponsor Bank Code I/We hereby authorize TVS Credit Services Limited

to debit (tick ) SB/CA/CC/SB-NRE/SB-NRO/Other Bank a/c number

with Bank IFSC/MICR

an amount of Rupees
DEBIT TYPE Fixed Amount Maximum Amount FREQUENCY Monthly Quarterly Half Yearly Yearly As & when presented

Customer ID Prospect No.


1.I agree for the debit of mandate processing charges by the bank whom I am authorizing to debit my account as per latest schedule of charges of the bank. 2.This is to confirm that the declaration
has been carefully read, understood & made by me/us. I am authorizing the User entity / Corporate to debit my account. 3.I have understood that I am authorized to cancel/amend this mandate by
appropriately communicating the cancellation / amendment request to the User entity / corporate or the bank where I have authorized the debit.

From D D M M Y Y Y Y

To D D M M Y Y Y Y
Or Until Cancelled
Signature Primary Account Holder Signature Account Holder Signature Account Holder
Phone No.
1. Name as in bank records 2. Name as in bank records 3. Name as in bank records
TVS Credit Services Limited
Consumer Durables Loan
OSV Declaration
I hereby confirm that I have verified the original KYC document of the below customer, and that the documents and details given below pertain to
verification of Loan Number 3047CD0440874

Snapshot of KYC Details


Prospect Number 3047CD0440874
Customer Name MOHIT kumar
Employee/Dealership Name INFINITI RETAIL LIMITED
Employee Code/Dealership Code CD153086
OSV Esign DateTime 26-01-2025 08:53 PM

Id Proof - AADHAAR Prospect Number - 3047CD0440874 Id Proof Number - 8650

Original of Id Proof has been seen and verfied (Signature of Dealer/Employee) , as on 26/01/2025 08:53 PM
Lat/Long 28.4025569 76.9470698
Address Proof -
Prospect Number - 3047CD0440874 Address Proof Number - 8650
AADHAAR

Original of Address Proof has been seen and verfied (Signature of Dealer/Employee) , as on 26/01/2025 08:53 PM
Lat/Long 28.4025569 76.9470698

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