UMRN Date 1/1/2023

Sponsor Bank Code UBIN0557757 Utility Code UBIN00189000024884

I/We hereby authorise UNION BANK OF INDIA to debit (tick) SB/CA/CC/SB-NRE/SB-NRO

Tick
CREATE Bank A/c Number 12345678
MODIFY
Andhra Pradesh
CANCEL
with Bank Grameena Vikas Bank IFSC SBIN0000001 MICR

an amount of Rupees Ten Thousands 10000

Frequency Mthly Qtly H-Yrly Yrly As & when presented Debit Type Fixed Amount Maximum Amount

Reference 1 310016650000001 Phone Number 9999999999

Reference 2 ABC Ltd Email ID abc@gmail.com
I/we agree for the debit of Mandate Processing Charges by the Bank where I am authorising to debit my accountas per latest schedule of charges of the Bank

Period

From 2/1/2023
To

Or Until Cancelle ABC Limited 0 0

This is to confirm that the declaration has been carefully read, understood and made by me/us. I/we are authorising the user entity/corporate to debit my account, based on the instructions as agreed and signed by
me.

I have understood that I am authorised to cancel/amend this mandate by appropriately communicating cancellation/amendment request to the user entity/corporate or Bank where I have authorised the debit.
Mandate Type CREATE
MODIFY
CANCEL