Employees’ Provident Fund Organisation, RO Mumbai-t 344, Bhavishya Nidhi Bhavan, Bandra (E), Mumbai-400 054. ELECTRONIC CLEARING SERVICE (CREDIT CLEARING) MANDATE FROM INVESTOR-CUSTOMER OPTION TO REGEIVE PAYMENTS THROUGH GREDIT CLEARNING MECHNISH {TO BE SUBMITTED ALONG WITH FORM-1 9f20131/10-C) . MEMBER'S NAME (CUSTOMER,S NAME) : 2 PARTICULARS OF BANK ACCOUNT AY BANK NAME B) BRANCH NAME c) 9-DIGIT CODE NUMBER OF THE BANK AND BRANCH APPEARING ON THE MICR: CHEQUE ISSUED BY THE BANK PLEASE ATACH ASLANK CANCELLED CHEQUE ISSUED BY YOUR BANK FOR VERIFYING THE ACCURACY OF THE MICR CODE NUMBER. IF A SALARY A/C. IS MENTIONED, PLEASE ENSURE THAT ‘THE AC. IS LIVE TILL AMOUNT 15 GREDITO. D) ACCOUNT TYPE WITH SAVING BANK ACCOUNT CODE 10/14/13 E) — S.B. AVC, NO. (AS APPEARING) ON THE CHEQUE BOOK Fy IFSC CODE . al” NeFT NO. 3. DATE OF EFFECT |, hereby declare that the particulars given above are correct and complete. ff the transaction is delayed or not effected at all for reasons of incomplete or incorrect information, I would not hold the user institution responsible. | have head the option fetter end agree to discharge the responsibility expected of me as a participant under the scheme. Date: Signature of the Customer / Member CERTIFICATE OF CUSTOMER'S BANK(**) CERTIFIED THAT THE PARTICULARS FURMISHED ABOVE ARE CORRECT AS PER OUR RECORDS. BANK STAMP Date SIGNATURE OF THE AUTHORISED. OFFICIAL OF THE BANK AND NAME BANK BRANCH CODE NO ((*) Note : Certificate of the customer's Bank is required only if the member Is unable to enclose blenk canceled cheque of his 8.8, Arc,