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SC0016CFPA72OM

The document is a debit mandate authorization for PINE LABS PVT LTD to debit an amount of Rs. 7000 from the account of the primary account holder, Kultar Singh Malhotra, at HDFC Bank. The debit will occur as and when presented, and the account holder acknowledges understanding the terms and conditions, including the ability to cancel or amend the mandate. The document includes necessary details such as bank codes, account numbers, and signatures for validation.

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malhotraprabhnoor
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27 views1 page

SC0016CFPA72OM

The document is a debit mandate authorization for PINE LABS PVT LTD to debit an amount of Rs. 7000 from the account of the primary account holder, Kultar Singh Malhotra, at HDFC Bank. The debit will occur as and when presented, and the account holder acknowledges understanding the terms and conditions, including the ability to cancel or amend the mandate. The document includes necessary details such as bank codes, account numbers, and signatures for validation.

Uploaded by

malhotraprabhnoor
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

UMRN Date 0D 9

D 0
M 6
M 2Y 0Y 2Y 5Y
Utility Code HDFC 0 0 0 4 1 0 0 0 0 0 2 5 7 9 ✔ CREATE MODIFY CANCEL

Sponsor I/We hereby


Bank Code ICIC0TREA00 authorize PINE LABS PVT LTD
to debit
(t ick )
SB ✔ CA CC SB-NRE SB-NRO Other Bank a/c number 5 0 2 0 0 0 3 1 5 6 4 1 7 3
with Bank HDFC Bank IFSC/ MICR HDFC0 0 0 3 7 5 6
an amount of Rupees Seven Thousand Only ` 7000.00

DEBIT TYPE Fixed Amount ✔ Maximum Amount FREQUENCY Monthly Quarterly Half Yearly Yearly ✔ As & when presented

Reference 1 4948336 Reference 2


1. 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. 2. This is to confirm
that the declaration has been carefully read, understood and made by me/us. I am authorizing the user entity/corporate to debit my account, based on the instructions as
agreed and signed by me. 3. 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.

From 1D 0
D 0
M 6
M 2Y 0Y 2Y 5Y
To 0D 9
D 0
M 6
M 2Y 0Y 6Y 5Y
OR Until Cancelled Signature of primary account holder Signature of account holder Signature of account holder

Phone No. 9 8 9 1 4 0 4 6 0 7 KULTAR


Name SINGH MALHOTRA
as in bank records Name as in bank records Name as in bank records
1 2 3

Print this page on A4 paper.


Sign above your name.
Sign with exactly the same signature as that which is recorded by your
bank. Do not write anything else or modify the mandate in any way.
If you need to change anything, ask your merchant for an updated
mandate. Give the signed mandate to your merchant.

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