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Mandate Form (Electronic Clearing Services (Debit Clearing)

The document is a mandate form authorizing a bank to debit a customer's account for loan payments through electronic clearing services. It provides the customer's bank details including the 9-digit code, account type, account number, and transaction details such as date of effect, periodicity, and amount. The customer signs to acknowledge responsibility and authorize the bank to process transactions according to the information provided.

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rajaraja08
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113 views1 page

Mandate Form (Electronic Clearing Services (Debit Clearing)

The document is a mandate form authorizing a bank to debit a customer's account for loan payments through electronic clearing services. It provides the customer's bank details including the 9-digit code, account type, account number, and transaction details such as date of effect, periodicity, and amount. The customer signs to acknowledge responsibility and authorize the bank to process transactions according to the information provided.

Uploaded by

rajaraja08
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 DOCX, PDF, TXT or read online on Scribd
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MANDATE FORM (ELECTRONIC CLEARING SERVICES (DEBIT CLEARING)

The Manager (Bank Name) State Bank of Hyderabad (Branch Name) Market Complex Branch (Address) C1, Periyar Vegrtable Market Koyambedu, Chennai 600092 Telephone No 24796526

Copy to the user company

I hereby authorize you to debit my account for making payment tp Loan A/C No 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: ( S.B. Account/Current Account or Cash Credit) C. LEDGER NO/ LEDGER FOLIO NO. D. ACCOUNT NUMBER Name of the Date of Scheme effect Periodicity Amount of (M/Bim?Qtly/etc) installment/Amt of bill with upper limit Number of installments/Valid up to (in case of utility bills)

E. Date of effect
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. NAME : MOBILE NO : DATE :

(..) Signature of the Customer Certified that the particulars furnished above are correct as per our records (Bank Stamp) Date: Signature of the Authorized Official from the Bank

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