|
MANDATE FORM |
| 1. YOUR P.A.N. NUMBER/ GIR NUMBER |
| 2. YOUR NAME & ADDRESS |
| 3. THE NAME OF YOUR BANK AND BRANCH ADDRESS |
| 4. THE NINE DIGIT CODE NUMBER OF YOUR BANK AND BRANCH |
| 5. YOUR ACCOUNT TYPE (SAVINGS / CURRENT / CASH CREDIT) |
| 6. YOUR ACCOUNT LEDGER FOLIO (IF ANY) |
| 7. YOUR ACCOUNT NUMBER (AS APPEARING IN YOUR CHEQUE BOOK) |
| 8. AND THE FOLLOWING DECLARATION |
| "I hereby declare
that the particulars given are correct and complete. If the
transaction is delayed or not effected, for reasons of incomplete or incorrect information, i would not hold the user institution responsible. I agree to discharge the responsibility expected of me as a participant under the ECS." |
|
Signature of Assessee |
| ATTACH A CANCELLED BLANK CHEQUE OF YOUR BANK A/C. |