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Bank Mandate Form

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sujitpaikaray730
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595 views1 page

Bank Mandate Form

Uploaded by

sujitpaikaray730
Copyright
© © All Rights Reserved
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

(Account’s/Information form)

ELECTRONIC CLEARING SERVICE (CREDIT CLEARING) / REAL TIME GROSS


SETLEMENT(RTGS)/ NATIONAL ELECTRONIC TRANSFER (NEFT) / INTRA BANK
ACCOUNT TRANSFER FACILITY FOR RECEIVING PAYMENTS

A. BANK ACCOUNT DETAILS:


NAME OF ACCOUNT HOLDERER / FIRM
COMPLETE CONTACT ADDRESS

MOBILE NUMBER / PH NO
E. MAIL

B. BANK ACCOUNT DETAILS:


ACCOUNT NAME
(Name appearing in your Cheque Book)
BRANCH NAME WITH COMPLETE
ADDRESS,
TELEPHONE NO
BRANCH CODE

COMPLETE BANK ACCOUNT NUMBER


(Please
note that the Bank Account must be in the name of
the Firm as appeared in the bill. In Case of other
Beneficiaries (Non-vendor) the Account name must
he in the name of Applicant.
IFSC CODE

TYPE OF ACCOUNT (SB/CURRENT/CASH CREDIT)


MICR CODE OF BANK

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 (IGGL) responsible. I have read the
option invitation letter and agree to discharge responsibility expected or me as a participant
under the scheme.

Signature of Customer
Date:

Certified that the particulars furnished above are correct as per our records.

(Bank's Stamp)

Signature of Bank Authority

N.B:
Please attach a Cancelled Cheque/Passbook front page along with the
account information form.

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