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Revised ECS Mandate Format

This document is an electronic clearing service (debit clearing) mandate form that customers can fill out to authorize their bank to debit their account for payments to ICICI Bank Limited through ECS debit clearing. The form requests information such as the customer's account number and type, the debit details including amount and frequency, and requires the customer's signature to authorize the transactions. Upon obtaining the necessary information and signature, the bank can then process ECS debit clearing transactions on behalf of the customer.

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Monu Sharma
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312 views1 page

Revised ECS Mandate Format

This document is an electronic clearing service (debit clearing) mandate form that customers can fill out to authorize their bank to debit their account for payments to ICICI Bank Limited through ECS debit clearing. The form requests information such as the customer's account number and type, the debit details including amount and frequency, and requires the customer's signature to authorize the transactions. Upon obtaining the necessary information and signature, the bank can then process ECS debit clearing transactions on behalf of the customer.

Uploaded by

Monu Sharma
Copyright
© Attribution Non-Commercial (BY-NC)
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
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FORM NO.

E-5

Appendix VIII

LAN No.
(Only for official use)
ELECTRONIC CLEARING SERVICE (DEBIT CLEARING) MANDATE FORM
Please fill-in the information in Capital letters
The Manager

Copy to the User Company

(Bank Name)___________________________________________________________
(Branch Name)_________________________________________________________
(Address) _____________________________________________________________
Telephone No._________________________________________________________

Name ---------------------------Address -----------------------------------------------------------Telephone No.------------------

I (* Account Holder Name) ________________________________________________________________________ (as per Bank records) hereby


authorize you to debit my account for making payment to `ICICI Bank Limited through ECS (Debit) clearing as per the details given as
under.
A. * 9-DIGIT CODE NUMBER OF THE BANK & BRANCH:
(Appearing on the MICR cheque issued by the bank
B. * ACCOUNT TYPE

Savings : (10 / 31) / Current : (11 / 29) / Cash Credit : (13) / NRE / NRO

C. LEDGER NO / LEDGER FOLIO NO.


:
D. * ACCOUNT NUMBER (As per Bank Records)

Name of the Scheme

Date of effect Periodicity


(M/BiM/Qly/etc.)

E.

Date of effect

Amount of installment/ Amt Number of installments/ Valid


of bill with upper limit
up to (in case of utility bills)

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 of the
Customer (Account Holder/s) - In case of Joint A/c holders, Signature is required of all A/c holders.
Date :
Certified that the particulars furnished above are correct as per our records.
(Banks Stamp)
Date :

--------------------------------------------Signature of the Authorized official from the Bank

(Note:- Mandate to be obtained in 3 copies, Original for Bank, One for User Co. and other for customer)
For ICICI BANK LTD Use only (To be filled by Business Team)
Name of the Applicant __________________________________________________________________________________
Name of the co-applicant________________________________________________________________________________
Bank Name___________________________________ Branch____________________ City __________________________
Application
Number_____________________________________________________________________________________
Fresh_____________Swap__________________ In case of Swap previous mode________________________________

* Mandatory Fields

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