Debit Mandate Form NACH / ECS / DIRECT DEBIT

UMRN Date 0 8 1 2 2 0 1 9
Tick( ) Sponsor Bank Code Utility Code
CREATE I/We hereby authorize TVS Credit Services Limited to debit (tick ) SB CA CC SB-NRE SB-NRO Other
MODIFY
CANCEL Bank a/c number 0 4 6 0 1 0 1 0 6 4 2 1 4
with
Bank CANARA BANK IFSC CNRB 0 0 0 0 4 6 0 or MICR

an amount of
Rupees THREE THOUSAND ONE HUNDRED AND TWENTY SIX ONLY 3126 /-
FREQUENCY Monthly Quarterly Half Yearly Yearly As & when presented DEBIT TYPE Fixed Amount Maximum Amount

Prospect No. 3025CD0136638 Phone No. 9964645124

Agreement No. Email ID
I agree for the debit of mandate processing charges by the bank whom I am authorizing to debit my account as per latest schedule of charges of the bank.
PERIOD
From 0 3 0 1 2 0 2 0
Signature of account holder Signature of account holder Signature of account holder
To D D MM Y Y Y Y
Or Until Cancelled SHAHEEN SHAHEEN 2. Name as in bank record 3. Name as in bank record
This is to confirm that the declaration has been carefully read, understood & made by me/us. I am authorizing the User entity / Corporate to debit my account. I have understood that I am authorized to cancel/amend this
mandate by appropriately communicating the cancellation / amendment request to the User entity / corporate or the bank where I have authorized the debit.

Debit Mandate Form NACH / ECS / DIRECT DEBIT

UMRN Date D D MM Y Y Y Y
Tick( ) Sponsor Bank Code Utility Code
CREATE
I/We hereby authorize to debit (tick ) SB CA CC SB-NRE SB-NRO Other
MODIFY
CANCEL Bank a/c number

with Bank IFSC or MICR

an amount of Rupees
FREQUENCY Monthly Quarterly Half Yearly Yearly As & when presented DEBIT TYPE Fixed Amount Maximum Amount
Phone
Prospect No.
No.
Agreement
Email ID
No.
I agree for the debit of mandate processing charges by the bank whom I am authorizing to debit my account as per latest schedule of charges of the bank.
PERIOD
From D D MM Y Y Y Y
Signature of account holder Signature of account holder Signature of account holder
To D D MM Y Y Y Y
Or Until Cancelled 1. Name as in bank record 2. Name as in bank record 3. Name as in bank record
This is to confirm that the declaration has been carefully read, understood & made by me/us. I am authorizing the User entity / Corporate to debit my account. I have understood that I am authorized to
cancel/amend this mandate by appropriately communicating the cancellation / amendment request to the User entity / corporate or the bank where I have authorized the debit.

Debit Mandate Form NACH / ECS / DIRECT DEBIT

UMRN Date D D MM Y Y Y Y
Tick( ) Sponsor Bank Code Utility Code
CREATE
I/We hereby authorize to debit (tick ) SB CA CC SB-NRE SB-NRO Other
MODIFY
CANCEL Bank a/c number

with Bank IFSC or MICR

an amount of Rupees
FREQUENCY Monthly Quarterly Half Yearly Yearly As & when presented DEBIT TYPE Fixed Amount Maximum Amount
Phone
Prospect No.
No.
Agreement
Email ID
No.
I agree for the debit of mandate processing charges by the bank whom I am authorizing to debit my account as per latest schedule of charges of the bank.
PERIOD
From D D MM Y Y Y Y
Signature of account holder Signature of account holder Signature of account holder
To D D MM Y Y Y Y
Or Until Cancelled 1. Name as in bank record 2. Name as in bank record 3. Name as in bank record
This is to confirm that the declaration has been carefully read, understood & made by me/us. I am authorizing the User entity / Corporate to debit my account. I have understood that I am authorized to
cancel/amend this mandate by appropriately communicating the cancellation / amendment request to the User entity / corporate or the bank where I have authorized the debit.