TATA ‘TATA POWER FORM NO. E-5 MANDATE FORM ELETRONIC CLEARING SERVICE (DEBIT CLEARING) Copy to the User Company ‘thaNianaper Customer No.. Bank A/C Holder's Name.. (Bank Name) Address (Branch Name) ‘nares Landline No.. Mobile No.. Tetephone No, Email | hereby authorize you to debit my account for making payment to the Tala Power Company Ltd. through ECS (Debit) clearing as per the details given under: A 9-DIGIT CODE NUMER OF THE BANK & BRANCH a a Bo a ea ea Seat | onc the MR chee dye a) B. ACCOUNT TYPE (5.8 Account/Current Account or Cash Credit ©. LEDGERNO. | LEDGER FOLIO NO. 0 vcowrmmees (TTP Pt ‘Number of installments/ Valid up to (in case of utiity ills) ._tfective date on which the account isto be debited {Discount Date [Due Date tint ices ot eta | hereby declare that the particulars given above are correct and complete. Ifthe transaction is delayed or not effected at all for reasons of ‘incomplete or incorrect information, | would not hold the user institution responsible. | have read & agree to the instructions mentioned in the ECS leaflet provided herewith. Gaal Signature of the Customer Certified that the particulars furnished above are corret | as per our records, (Gank’s Stamp) Signature of the Authorised Official ‘from the Bank Note: 1. (Please enloe canceled cheque a copy of cheque, 2. leas send the oy ile In Mandate fer to Deputy General Manager (Customer Management Department), The Tata Power Company I, Dhar ecevng Statin, Net Shalimar Industral Exate, Maton, Marbst = 0019 | Cll Centre No. (el Fre) #800-208516t 2. ECS wl be activated within 30 ays rom sbmision of the competed From