Debit Authorization For the Financial Year 2019-2020

Student ID : 000061920394

Name of the Student : Toleti Mounica

Account Number :

1 4 2 0 0 1 5 2 5 5 2 8

This is to authorize to debit my account for the bills raised by Indian School of Business
of any of the following items.

1. Spouse / Guest Meal

2. Telephone Expenses
3. Photocopying
4. Library dues
5. Guest Accommodation Charges
6. Any other items for which bill(S) are raised by Indian School of Business

I also understand that for Hyderbadad ICICI Bank Ltd / for Mohali - Indian Bank.

1) Will not be responsible for the correctness or accuracy of the Bill amount raised by
ISB and I shall contact ISB for the same.

2) Will not intimate me if debit could not be executed for insufficient balance in my
account.

Signature :