Dear Sir,

Re. : Payment through Electronic Clearing Systems (ECS) / National Electronic Fund Transfer (NEFT)

With reference to your mail dated I/We hereby give my/our mandate to credit in my/our account through the
Electronic Clearing Systems (ECS) / National Electronic Fund Transfer (NEFT) the payment due to me/us. The details of the Bank
Account are given below:-

Name of Benificiary
(In Block Letter

Address
I/We enclosed herewith a photocopy of cancelled cheque to enable you to verify the details mentioned above.

I/weMobile
hereby declare
No. of that the particulars given above are correct and complete. If the transaction is delayed or lost bacuse of
incomplete or incorrect information; I/we would not hold the company/the institution responsible.
Benificiary

E-Mail id of
Plac
Benificiary
e:
Date
Name of the Bank and Branch Stamp & Sign of Benificiary / or
their authorised Person
:
Telephone No. of Bank

VERIFIED / ATTESTED BY THE BANKER THAT THE ABOVE DETAILS ARE TRUE AND CORRECT
Address of Bank

Bank official Signature and Stamp

9 Digit code no. of the bank and with name
branch as appearing on the
MICR cheque issued by the bank

IFSC Code for NEFT / RTGS

Type of Account

Account No. as appearing on the

Cheque Book (Not exceeding of
15 Digits)