MANDATE FORM

RTGS / NEFT / ECS (CREDIT CLEARING)

Dear Sir / Madam,

Sub: - Authorization for payments through Electronic mode / system.

** ** **
I / we hereby authorize to make all our payments through electronic mode / system.

The details for facilitating the payments are given below:

1 NAME OF ACCOUNT HOLDER

2 COMPLETE CONTACT ADDRESS
3 TELEPHONE NUMBER
E-MAIL (For intimating regarding
4
release of payments)
5 PAN NO.
6 GST NO.
7 BANK NAME
8 BRANCH NAME WITH ADDRESS
9 ACCOUNT NUMBER
10 IFSC CODE
11 TYPE OF ACCOUNT (SB/CURRENT)
12 MICR CODE OF BANK

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.

Date: (Signature of the Beneficiary)