MANDATE
FORM FOR INDIVIDUALS
Electronic
Clearing Service (Credit Clearing/Real Time Gross Settlements (RTGS) Facility
for Receiving Payment
A. Details of Account Holder
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1.
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Name of the Account Holder
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2.
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Complete contact address
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3.
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Telephone number/fax/email
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B. Bank Account Details:
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1.
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Bank Name
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2.
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Branch name with complete address, telephone number
and email
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3.
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Whether branch is computerized
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4.
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Whether the branch is RTGS enabled. If yes, what is
the IFSC code?
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5.
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Is the branch also NEFT enabled
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6.
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Type of bank account (SB, Current/Cash credit)
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7.
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Complete bank account number (latest)
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8.
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MICR code of the bank
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Date of Effect-
I
hereby declare that the particulars given 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 the read option invitation letter and agree to discharge responsibility
expected of me as a participant under the Scheme.
Signature
of Customer
Certified that the particulars furnished above are correct as per records.
(Bank
Stamp)
Dated:-……………..
Signature
of the Authorized officer from the Bank
1. Please attach a photocopy of cheque along with the verification obtained from the Bank.
2.
in case your Bank Branch is presently not , “RTGS enabled” then upon up
gradation to RTGS Enabled” branch. Please submit the information again in the
above proforma to the Department at the earliest.
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