Debit Mandate Form NACH/ECS/DIRECT DEBIT

UMRN Date 1 7 1 2 2 0 2 2
Tick(✓) Spons or Bank Code ICI0TREA00 Utility Code ICIC00261000001992
CREATE ✓
I/We hereby authorize CapFloat Financial Services Pvt Ltd to debit (tick ✓) SB /CA /CC/SB-NRE /SB-NRO /Other
MODIFY
CANCEL Bank a/c number 3 1 9 2 2 2 5 9 1 1
with Bank Central Bank of India IFSC C B I N 0 2 8 0 7 0 5 or MICR

an amount of Rupees Two Lakh, Thirty-One Thousand And One ₹231001

FREQUENCY Mthly Qtly H-Yrly Yrly As & when pres ented DEBIT TYPE Fixed Amount ✓ Maximum Amount

Client ID VACAFLT449678652244 Phone No. 8600530329

Ref. ID Email ID
I agree for the debit of mandate proc essing c harges by the bank to whom I am authoriz ing to debit my ac c ount as per latest sc hedule of c harges of the bank.
Period
From 1 7 1 2 2 0 2 2
To 1 7 1 2 2 0 2 5 Signature Primary Account holder Signature Primary Account holder Signature Primary Account holder

Or Until Cancelled 1. Name as in bank records 2. Name as in bank records 3. Name as in bank records

This is to confirm that the declaration has been carefully read, understood and made by me/us. I am authorising the user entity/Corporate to debit my account.
I have understood that I am authorised to cancel/amend this mandate by appropriately communicating the cancellation/ amendment request to the user entity/Corporate of the bank where I have authorized the debit.

Debit Mandate Form NACH/ECS/DIRECT DEBIT

UMRN Date 1 7 1 2 2 0 2 2
Tick(✓) Spons or Bank Code ICI0TREA00 Utility Code ICIC00261000001992
CREATE ✓
I/We hereby authorize CapFloat Financial Services Pvt Ltd to debit (tick ✓) SB /CA /CC/SB-NRE /SB-NRO /Other
MODIFY
CANCEL Bank a/c number 3 1 9 2 2 2 5 9 1 1
with Bank Central Bank of India IFSC C B I N 0 2 8 0 7 0 5 or MICR

an amount of Rupees Two Lakh, Thirty-One Thousand And One ₹231001

FREQUENCY Mthly Qtly H-Yrly Yrly As & when pres ented DEBIT TYPE Fixed Amount ✓ Maximum Amount

Client ID VACAFLT449678652244 Phone No. 8600530329

Ref. ID Email ID
I agree for the debit of mandate proc essing c harges by the bank to whom I am authoriz ing to debit my ac c ount as per latest sc hedule of c harges of the bank.
Period
From 1 7 1 2 2 0 2 2
To 1 7 1 2 2 0 2 5 Signature Primary Account holder Signature Primary Account holder Signature Primary Account holder

Or Until Cancelled 1. Name as in bank records 2. Name as in bank records 3. Name as in bank records

This is to confirm that the declaration has been carefully read, understood and made by me/us. I am authorising the user entity/Corporate to debit my account.
I have understood that I am authorised to cancel/amend this mandate by appropriately communicating the cancellation/ amendment request to the user entity/Corporate of the bank where I have authorized the debit.

Debit Mandate Form NACH/ECS/DIRECT DEBIT

UMRN Date

Tick(✓) Spons or Bank Code ICI0TREA00 Utility Code ICIC00261000001992

CREATE ✓
I/We hereby authorize to debit (tick ✓) SB /CA /CC/SB-NRE /SB-NRO /Other
MODIFY
CANCEL Bank a/c number

with Bank IFSC or MICR

an amount of Rupees ₹
FREQUENCY Mthly Qtly H-Yrly Yrly As & when pres ented DEBIT TYPE Fixed Amount ✓ Maximum Amount

Client ID Phone No.

Ref. ID Email ID
I agree for the debit of mandate proc essing c harges by the bank to whom I am authoriz ing to debit my ac c ount as per latest sc hedule of c harges of the bank.
Period
From

To Signature Primary Account holder Signature Primary Account holder Signature Primary Account holder

Or Until Cancelled 1. Name as in bank records 2. Name as in bank records 3. Name as in bank records

This is to confirm that the declaration has been carefully read, understood and made by me/us. I am authorising the user entity/Corporate to debit my account.
I have understood that I am authorised to cancel/amend this mandate by appropriately communicating the cancellation/ amendment request to the user entity/Corporate of the bank where I have authorized the debit.

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