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Important Instructions For Filling Ach Mandate Form: Hdfcbankltd

This document is an ACH mandate form authorizing HDFC Bank Ltd. to debit Rs. 1649 from Dalwinder Singh's ICICI Bank account number 662 501 560 271 on a monthly basis. The debit is related to a consumer durable loan with reference number 57826A00122. The form provides instructions for properly filling out the mandate.

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802 views1 page

Important Instructions For Filling Ach Mandate Form: Hdfcbankltd

This document is an ACH mandate form authorizing HDFC Bank Ltd. to debit Rs. 1649 from Dalwinder Singh's ICICI Bank account number 662 501 560 271 on a monthly basis. The debit is related to a consumer durable loan with reference number 57826A00122. The form provides instructions for properly filling out the mandate.

Uploaded by

FUTURE NEXTTIME
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
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ACH MANDATE FORM

UMRN Date 2 3 0 2 2 0 2 2
Tick( ) Sponsor Bank Code H D F C 0 0 0 0 0 1 5 Utility Code H D F C 0 0 0 1 7 0 0 0 0 0 1 1 0 3
Create
HDFCBANKLTD
Modify X I/We hereby authorize
To Debit (Tick ) SB CA CC SB-NRE SB NRO Others

Cancel X Bank a/c Number 6 6 2 5 0 1 5 6 0 2 7 1


with Bank ICICI BANK LTD IFSC I C I C 0 0 0 0 4 0 2 or MICR 1 4 4 2 2 9 0 0 2
an amount of Rupees One Thousand Six Hundred and Forty Nine Only 1649
Frequency Mthly Qtly H-Yrly Yrly As & When presented Debit Type Fixed Amount Maximum Amount
Reference 1 57826A00122 Phone No. 9877645429
Reference 2 Consumer Durable Loan E-mail ID
PERIOD 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.

From
Signature Account Holder Signature Account Holder Signature Account Holder
To X X X X X X X X
Or Until Cancelled
1 DALWINDER SINGH 1 DALWINDER SINGH 1 DALWINDER SINGH
This is to confirm that the declaration has been carefully read, understood & made by me / us. I am authorizing the User entity / Corporate to debit my account, based on the instructions as
agreed & signed by me. 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 debit.

--- ------------------------------------------------------------------------------------------------------------------------------

IMPORTANT INSTRUCTIONS FOR FILLING ACH MANDATE FORM

1.Following fiields need to be filled mandatorily in Black and


Capital Letters: 2. In case of Cooperative Banks please check with your bank on
IFSC/MICR valid for ACH purposes.
Please mention date in format dd/mm/yyyy 3. In case of account type - Cash Credit/OD please check with your
Please tick bank account type viz SB for Saving Bank, CA for bank on acceptance odf ACH debit mandate on these account
current account type
Bank account number valid for ECS/RTGS/NEFT as appearing 4. Pleas ensure no overwrititing on mandate form.
in account statement 5. Please do not write/tick on following fields: 1,7,6,14,15
Bank & Branch name where account is held 6. Please take printout on good quality A4 paper & tear across the
IFSC/MICR code valid fopr ACH as per account line marked with scissor.
statement/Cheque. 7. Form to be submitted along with copy of latest bank account
Amount on mandate in words & figure. statement to nearest retail Assest Branch.
Reference No 1 -Mention Loan account number
Reference No 2 : Mention Loan type
Mobile number & email ID
Period:-To not be filled.
Signature - asper bank records ensure there is no variation in
signature from bank records
Name: As per Banks records in full and in Capital.

--- ------------------------------------------------------------------------------------------------------------------------------
ACH MANDATE FORM
UMRN Date 2 3 0 2 2 0 2 2
Tick( ) Sponsor Bank Code H D F C 0 0 0 0 0 1 5 Utility Code H D F C 0 0 0 1 7 0 0 0 0 0 1 1 0 3
Create
I/We hereby authorize HDFCBANKLTD To Debit (Tick ) SB CA CC SB-NRE SB NRO Others
Modify X
Cancel X Bank a/c Number 6 6 2 5 0 1 5 6 0 2 7 1
with Bank ICICI BANK LTD IFSC I C I C 0 0 0 0 4 0 2 or MICR 1 4 4 2 2 9 0 0 2
an amount of Rupees One Thousand Six Hundred and Forty Nine Only 1649
Frequency Mthly Qtly H-Yrly Yrly As & When presented Debit Type Fixed Amount Maximum Amount
Reference 1 57826A00122 Phone No. 9877645429
Reference 2 Consumer Durable Loan E-mail ID
PERIOD 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.

From
Signature Account Holder Signature Account Holder Signature Account Holder
To X X X X X X X X
Or Until Cancelled
1 DALWINDER SINGH 1 DALWINDER SINGH 1 DALWINDER SINGH
This is to confirm that the declaration has been carefully read, understood & made by me / us. I am authorizing the User entity / Corporate to debit my account, based on the instructions as
agreed & signed by me. 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 debit.

--- ------------------------------------------------------------------------------------------------------------------------------

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