NACH/ECS/AUTO DEBIT UMRN Date 0 7 0 1 2 0 2 3Y

MANDATE INSTRUCTION FORM

Tick ( ) Sponsor Bank Code HDFC0000070 Utility Code YESB00709000028661
CREATE
I/We hereby authorize ICCL to debit (tick ) SB/CA/CC/SB-NRE/SB-NRO/Other
MODIFY
CANCEL Bank a/c number 2 8 1 1 0 0 0 1 0 0 1 9 4 0 5 0
with Bank PUNJAB NATIONAL BANK IFSC P U N B 0 2 8 1 1 0 0 or MICR 7 2 1 0 2 4 9 0 1
an amount of Rupees ONE LAKHS RUPEES ONLY R 100000
FREQUENCY Mthly Qtly H-Yrly Yrly As & when presented DEBIT TYPE Fixed Amount Maximum Amount

Reference 1 (Mandate Reference No.) M6586135 Phone No. 9647087024

Reference 2 (Unique Client Code-UCC) Email ID SANAJITS.MS@GMAIL.COM

I agree for the debit of mandate processing charges by the bank whom I am authorizing to debit my account as per latest schedule of charges of the bank.
PERIOD
From 0 7 0 1 2 0 2 3
To 3 1 1 2 2 0 9 9 Signature of First Holder Signature of Second Holder Signature of Third Holder
Or Until Cancelled
1. Name of First Holder 2. Name of Second Holder 3. Name of Third Holder
- This is to confirm that the declaration has been carefully read, understood & made by me/us. I am authorizing the user entity/ Corporate to debit my account, based on the instructions as agreed and signed by me overleaf.
- I have understood that I am authorised to cancel/amend this mandate by appropriately communicating the cancellation / amendment request to the User entity / Corporate or the bank where I have authorized the debit.