Government of Karnataka Finance Department Department of Treasuries MANDATE FORM ecronic Clearing Service (ret Clearing Real Time Gross Settlement RTGS}/Natioal Electronic Fund “Transfer [NEF fit for reeling payments A.Detals of Accounts Hlders= Nome ofthe Recipient Fat Names ti capita eters), [second Name: in capita eters last Name: in caital eters) [Redhar Nomber a A [compete Office Address ladaress7 ladaress? emcone [Mabie Number ofthe vecient EMail (email ofthe recipient) is. Bank Account Details ofthe bank Name ranch Name Hvpe of Sank Account lease Select | saving pak Jewwore lhe type of Bank Account [Account Number as appearing the passbook) sit mick Code of Sank Branch [FSC Code ofthe Bank ate of eect: ‘hereby declare thatthe particulars given above ate corect and complete the transadion i elaed or not effected at all reasons afincomplete or incortet information | Would not hold the Depatment responsible. have ea the option invitation letter and agre to discharge responibt expected of me asa participant Under the Scheme, Date Signature ofthe candidate