P. 1
Annx

Annx

|Views: 1|Likes:
Published by George Oliver
ELECTRONIC CLEARING SERVICE (DEBIT CLEARING)
ELECTRONIC CLEARING SERVICE (DEBIT CLEARING)

More info:

Published by: George Oliver on Jul 22, 2013
Copyright:Attribution Non-commercial

Availability:

Read on Scribd mobile: iPhone, iPad and Android.
download as PDF, TXT or read online from Scribd
See more
See less

07/22/2013

pdf

text

original

Annx-II (To be obtained in Triplicate – One each to Destination Bank Branch, Home branch which has made the advance

, Customer) in System: Mandate Ref Number : Date of Entry

Contribution to This Account No: Account Name

ELECTRONIC CLEARING SERVICE (DEBIT CLEARING) MANDATE FORM CUSTOMER’S OPTION TO MAKE PAYMENTS THROUGH DEBIT CLEARING

1. Customer’s Name: 2. Particular’s of bank account: a. Bank Name: b. Branch name: c. 9-digit code number of the Bank & Branch appearing on the MICR cheque issued by the Bank (please attach the photocopy of a cheque or a blank cancelled cheque issued by your bank for verify the accuracy of the code number): d. Account type (SB Account/current Account or cash Credit) with code10/11/13: e. Ledger no/ledger folio no. : f. Account No:
as appearing in the cheque book): 3. Date of effect: The Details of the debits to be made and beneficiary are: Beneficiary Purpose of Amount payment
Indian Bank Branch:

No of Years

Start Date

End Date

Contribution

I, here by, declare that the particulars given above are correct and complete. I authorise you to debit my Account and pay the amount to Indian Bank under ECS. 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 payer/customer Date: Certified that the particulars furnished above are correct as per our records.

Bank’s seal: ( ) Date: Name:

SIGNATURE OF THE AUTHORISED/OFFICIAL OF THE BANK Designation:

You're Reading a Free Preview

Download
scribd
/*********** DO NOT ALTER ANYTHING BELOW THIS LINE ! ************/ var s_code=s.t();if(s_code)document.write(s_code)//-->