Download as pdf or txt
Download as pdf or txt
You are on page 1of 1

ECS DEBIT MANDATE

~::i;::m:::
115 P u njab & Siad B ank

··~·· !SB/CA/CC/SB-NRE/SB-NRO/Otherj
Sponsor Ba':_!~n~k~C~od:~•~:;::::;::;::::;::;:;::;:~;~U~tl~llty!~C~od~~•~~~~~;~~~;~;~~~~~~~~;~~~~~~~~~§~~~~~~~~~
I/We hereby authorize to debit (tick

Banka/cnumber j I I i I I I I lI
IFSC ! ! ! ! ! ! !or MICR! i f i f i
an amount of RupeesL_ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ___, i..;!~:,________......J
FREQUENCY Mthly Qtly H-Yrly D Yrly As & when Presented DEBIT TYPED Fixed Amount D Maximum Amount

Reference 21'============================:::l Phone


Reference No.::===============~
Emall ID
I agrwe for the debH of mandate prOCHslng charges by the bank whom I am •uthortzlng to debit my acc:ount n per latest schedule of c harges of tt. bank.
PERIOD.::;=;-;:::::::;:::::;-;:::::;::::;=;::::::::;i
FromITJITU ! ! ! !
To [TI[:I] - I -I -I -I
Or Until Cancelled
1 . _ _ _ _ _ _ _ _ _ _ _ 2. - - - ~ - - - - - - -
3.lnalNctfon
_ ,,,.. .. to c:onftnn th at.,_ CMdantto,i hu been c:.arefuly "Nd, underatood a fflacM by me/ua I am •ulhcM1iNne lhe LIHrentlly I Corporata to chbtt my accout,t. bued 0111he --- --
et aQf-.c1 and- - by,__
l,igned ----
- I ha.,. uno.r.t.:,ocl l "-1 I a m • ~ t o ~- the mar,dala b y ~ contlmNng lhec.anc.llationl amendm.nt ,.._In to ... U-wittty/ Corporat,9 or the bilnk ...__ I h a w ~ the det,k.

You might also like