NEFT/EFT Mandate form

(Payments through EFT mechanism)

1. Agents name:

2. Particulars of agents Bank Account:

A. Name of the Bank:

B. Name and Address of the Branch:

C. 9 – Digit code number of the bank and branch

appearing on the MICR cheque issued by the bank.
(I.e the MICR code number)

D. Account number (as appearing on the cheque book)

E. IFSC Code number of the bank

F. Type of account:
1. Saving account
2. Current account

G. E mail address – ( for receiving intimation via email for transfer of funds.)

H. Full address of the Agent

I. Phone No of the Agent

J. Agent pan no.-

(Please attach a blank cancelled cheque)

I hereby declare that the particulars given above are correct and complete. If
the transaction is delayed or not effected at all for reasons of incomplete or
incorrect information, I would not hold the user institution responsible. I have
read the option invitation letter and agree to discharge the responsibility
expected of me as a participant under the scheme.

(……………………)

Signature & Stamp of the Agent

Verified by:--------------------------

(Bank Official Stamp and Signature)