NEFT MANDATE FORM

1. Beneficiary Details
(a) Army No. Rank & Name of contact - Sh/Smt Mother
No. 4481906P
Rank Hav
Ravinder Singh
(b) Address Vill - Malke
Post - Malke
Teh – Baghapurana
Distt- Moga
(c) Mobile No. _______________
2. Particulars of Bank Account
(a) Account Title _________________________
(b) Name of the Bank _________________________
(c) Name of the Branch _________________________
Address _________________________
Tele No. _________________________
(d) 11 digits IFCS Code _________________________
(e) 9 digit MICR code No. of the bank and:
branch appearing on the MICR cheque issued
by the branch

(f) Type of the account saving/Current : Saving Bank

(g) Account number appearing on the cheque: Jt A/C No: _________________

(Please attached blank cancelled cheque or photocopy of the cheque)

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

Date 2022 (Signature/Thumb impression of NOK)

(Sh/Smt_________________________

Certified that the particulars furnished are correct as per records.

Dated 2022 Signature of Bank Manager

With round stamp

ATTESTED BY DISTRICT SAINIK WELFARE OFFICE