12012020 Pensioner’ letler of Authorty and Undertaking To, ANNEXURE 1 Pr. Controller of Communication Accounts Martin Burn House, 2nd Floor, IRN Mukharjee Road, Kolkota - 700 001 Sir, Thereby opt to draw my Pension through a Bank Account under the direct disbursement of telecom pension by DOT through SAMPANN. | hereby authorize the bank to receive my monthly Pension on my behalf and credit the same to ‘my account as per particulars given as follows: 1 | have to draw my pension/ family pension through the bank as per detail given below ~ a, Name of Bank ‘STATE BANK OF INDIA b. Branch ‘TERMINUS BUILDING NEW TOWN «. Account No. 38961142985 IFSC Code sBiN0014528 2, hereby undertake that any amount of excess/wrong payment of pension, if credited to my Bank Account will be refunded on your instructions, 3 undertake and agree to bind myself and my heirs, successors, executors and administrators to indemnify the Bank/ POA in so crediting my pension to my account under the scheme and to forthwith refund/pay any amount due from me to the Bank/PDA and also irrevocably authorize the BankiPDA to recover, any amount due from me by debit tomy % account or any other accounts/deposits belonging to me in possession of the Bank “ 2,01. READ Signature of Pensioner A. rie apse (1) Signature mC 2) Signature Melasg 2l Cosy Name: A@g2T27 SH Name SANKAT SARKCAR, Adtess 4.97743 Plat -38, Adress Type Br Qh Nv. 19, Bloee- Cy PAT Shoft. Kealyart, Neder Celerng Uladanay » Weibeade- 76706}1. Name of the Pensioner Mr. SUBHRA KANTI BISWAS 2. Designation SDE 3. Date of retirement 31/01/2020 4. Address of the Pensioner URSA COOPERATIVE HOUSING SOCIETY LIMITED FLAT NO 18 CE 1 C 199 PREMISES NO 03 177 ACTION AREA 1 BEHIND AXIS MALL NEWTOWN KOLKATA 700158 KOLKATA,24 PARAGANAS. NORTH,WEST BENGAL 700156 amily Pensioners only:- 5, Relationship with deceased 6. Name of the deceased government Servant pensioner 2, Bank Details:- 1, Saving (Current Account No. 38961142985, 2, Name of Bank STATE BANK OF INDIA 3, Name of the Branch TERMINUS BUILDING NEW TOWN 3 (a)Certified that the Bank details (2 above) are correct, The account of pensioner and his/her signature given overleaf agrees with the specimen signature held in our records. (b)Any excess amount credited in the account of the pensioner and due/refundable to the PDA will be refunded immediately as and when called for by the PDA. Notwithstanding anything contained in this clause 3(b), the Bank and the PDA agree and understand that the obligation cost on the Bank by medium of this clause{3(b)], shall be subject to:- i. The rights conferred and the duties imposed on the Bank by Law and/or norm andlor regulations, Place Signature of tho Bank Manager (Bank Accounts Seal) cs “Note Part 1 & 2 to be filled in by the pensioner and Part 3 by Balfig ss0i5 yeePensioner's letter of Authonty and Undertaking MANDATE EORM 1 Beneficiary Name BeneficiarylAddress & Telephone No. Beneficiary Account No, Account type ( Saving/Current for Cash Credit) with Code 10/11/13 Nine digit code number of the Bank & branch appearing on the MICR Cheque issued by the bank (if available) Bank Name Branch Name & Address with Telephone No. IFSC (Indian Financial Services Code) Photo copy of the cancelled cheque to confirm correctness of IFSC code and Account No. given Mr. SUBHRA KANTI BISWAS URSA COOPERATIVE HOUSING SOCIETY LIMITED FLAT NO 18 CE 1 C 199 PREMISES NO 03 177 ACTION AREA 1 BEHIND AXIS MALL NEWTOWN KOLKATA 700156 KOLKATA, 24 PARAGANAS NORTHWEST BENGAL,700156 & 9433000248 38961142985 Joint accounteither or survivor, with the spouse STATE BANK OF INDIA TERMINUS BUILDING NEW TOWN & ,, Pincode’ ‘SBINOO14528 \ hereby declare that the particulars glven above are correct and complete, Ifthe transaction 6 delayed or not effected at all for reasons of incompleteness or incorrectness of inform institution responsible. Dated 20.-202D Signature of Spouse Shstlery Dr's as wn given by me as above. | would not hold the user (Signature of the Beneficiery) Certified that tne particulars furnished above are, Correct as ner the. a oe ean sor wae of the Bath a respsisit) Bank Stamp (Signatud YR gjonsed offeor Za Dated waSHEA Ree Ge ce zevromommarnons spose tuners, =e Ul i op WM YY yy a ei 41 8m # OR BEARER eee awn! =| ‘ALOU €0LACS ATNOMCHE BRAN FORNON.CASHTRAMSACTON ONLY aa { ‘88 ACCOUNT Ss887d0000 MR. SUBHRA KANT BISWAS IMRS.SHELLEY BISW AS ‘CHEQUE Payable at Par at All Branches of SBI Please sign above “S8G97i" 700002429: COB2aaN 32