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Bank Mandate

This document is a mandate instruction form authorizing automatic debit from a bank account. It provides fields to select the type of account, bank details, amount, frequency of debit, references, and includes agreement and authorization for the debit along with details on cancelling or amending the mandate.

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rajandubey660
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59 views1 page

Bank Mandate

This document is a mandate instruction form authorizing automatic debit from a bank account. It provides fields to select the type of account, bank details, amount, frequency of debit, references, and includes agreement and authorization for the debit along with details on cancelling or amending the mandate.

Uploaded by

rajandubey660
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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NACH/ECS/AUTO DEBIT UMRN Date

MANDATE INSTRUCTION FORM


Utility Code Create Modify Cancel

Sponsor Bank Code I/We hereby authorize ICCL

to debit (tick ) SB/CA/CC/SB-NRE/SB-NRO/Other Bank a/c number

with Bank IFSC/MICR

an amount of Rupees `

DEBIT TYPE Fixed Amount Maximum Amount FREQUENCY Monthly Quarterly Half Yearly Yearly As & when presented

Reference 1 Reference 2

1) 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. 2) 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. 3) 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.

From Maximum period of validity of this mandate is 40 years only


To
Maximum period of validity of this
mandate is 40 years only

Phone No.: 1. 2. 3.

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