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ECS Service Provider
LlC Housing Finance Ltd.
Code No.
_

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ELECTRONIC

CLEARING SERVICE (DEBIT CLEARING)

MANDATE FORM

CUSTOMER'S ADVICE TO MAKE PAYMENTS THROUGH DEBIT CLEARING

LICHFL LOAN AlC 'NO.:
PAYMENT OF EMI

II I I I I I I II
..

1. CUSTOMER'S NAME
2. PARTICULARS OF BANK ACCOUNT
A. BANKNAME
B. BRANCHNAME
C. 9-DIGIT CODE NUMBER OF THE
BANK & BRANCH
APPEARING

ON THE MICR CHEQUE

(PLEASE ATTACH

THE PHOTOCOPY

A BLANK CANCELLED
FOR VERIFYING

CHEQUE

ISSUED BY THE BANK

OF A CHEQUE

OR

I I I I I 11 1 1 I

ISSUED BY YOUR BANK

THE ACCURACY

OF THE CODE NUMBER)

D.ACCOUNTTYPE
(S.B.Account 1Current Account or Cash Credit)
with code 10/11/13
E.LEDGER

NOJLEDGER FOLIO NO.

F. ACCOUNTNUMBER
(as appearing on the cheque book)
3. DATE OF EFFECT
Ihereby declare that the particulars given above are correct and complete.lf the transaction is delayed or
not effected at all for reasons of incomplete or incorrect information,l would not hold the user institution
responsible. Ihave read the invitation tetter and agree to discharge the responsibility expected of me as a
participant under the scheme.

Date
Place

Signature of the Customer

_

II II I II II
I II I II

Loan AlC No.1

FileNo.

Certified that the particulars furnished above are correct as per our records.

B~nk's Stamp:

Date:

Signature of the the Authorised IOfficial

from the Bank