Government of Karnataka Finance Department Department of Treasuries MANDATE FORM. Electronic Clearing Service (Credit Clearing Real Time Gross Settlement RTGS)National Electronic Fund Transfer (NEFT)facity for receiving payments ‘A.Details of Accounts Holders:- frst Name: [in capita letters), Name of the Recipient peel [in capital eters) |Aadhar Number TT TTT TTT ttt [address complete Address faaaressa lPCODE [Mabile Number of the | Be ee [e-Mail (e-mail ofthe ecplent) [B. Bank Account Details ofthe redpient- [| [| [ [ J J TT iBank Name Branch Name [select the type of Bank saving Bank Jcurent laccount - [Account Number (as appearing in the pass book) [ digit WICR Code of Bank Branch ifsc code ofthe bank | Date of effect: "hereby declare that the particulars glven above are correct and complete. Ifthe transaction is delayed or not effected at all reasons of incomplete or incorrect information | Would not hold the Department responsible. | have read the option invitation letter and agree to dstharge responsibilty expected of me asa participant under the Scheme. Date: ture ofthe candidate