Annexure 2

Electronic Clearing Service (Credit Clearing) Form

(Customers option to receive payments through Credit Clearing Mechanism)

Particulars of Customer
Name of Customer ITTEHAD FOUNDATION
(As appears on Pass Book of bank)
Address of Customer Vill: Chandkhira Basti, Po: Katabari, Ps:
Patharkandi,District: Karimganj, Assam,
Pin No: 788726

Contact Details of Customer Sahabuddin Ahmed , 8735934476 &

(Office number, phone no. and e-mail) ittehadfdn2021@gmail.com

PAN No. of Customer AAGCI0363RF

Particulars of Bank Account

Bank Name ICICI BANK LIMITED

Branch Name FARIDABAD - SECTOR 35

Address of Bank SCF-8-9-10, ASHOKA ENCLAVE-2, SEC-35,

FARIDABAD 121003

Telephone No. of Bank

Account Type Saving Account

(S.B. Account / Current Account or any other)

Account Number 085701002488

(as appears on the Cheque Book)
MICR No. 110229091
(9 digits code number of the Bank and Branch appears
on the cheque issued by the bank)
IFS Code of Bank ICIC0000857

I hereby declare that the particulars given above are correct and complete. If the transaction is delayed or not effected at all for
reasons of incomplete or incorrect information, I would not hold the user institution responsible. I have read the option
invitation letter and agree to discharge responsibility expected of me as a participant under the scheme.

Certified that the particulars furnished above are correct as per our records.
Date

Signature of Customer with Signature of Authorized bank official with common

common seal of the organization seal