Annexure B
Electronic Clearing Service (Credit Clearing)
(Model Mandate Form)
(Investor/Customers's option to receive payment through Credit Clearing Mechanism)
(Scheme Name and the Periodicity of payment)
1. INVESTOR/CUSTOMERS' Name : BHEDA KARAN BACHUBHAI
2. PARTICULARS OF BANK ACCOUNT
A. BANK NAME : STATE BANK OF INDIA
B. BRANCH NAME : KODINAR
ADDRESS : JIVRAJ MEHTA ROAD, KODINAR,GIR
SOMNATH, GUJARAT
TELEPHONE NO. : 22154
C. 9 DIGIT CODE NUMBER OF : 362002141
THE BANK & BRANCH
(Appearing on the MICR Cheque issued by the Bank)
C.1. IFSC Code of Bank : SBIN0060033
D. ACCOUNT TYPE : Saving Account
(S.B Account/Current Account or
Cash Credit with Code 10/11/13
E. LEDGER NO./LEDGER FOLIO NO. :
F. ACCOUNT NUMBER : 41242544858
(As appearing on the Cheque book)
G. Attached document for verification of Bank particular :
3. DATE OF EFFECT
I hereby declare that the particulars given above are correct and complete of the transaction
is delayed or not effected at all for reasons of incompleten or incorrect information. I would
not hold the user institution responsible. I have read the option invitation letter and agree to
discharge responsibilitybexpected of me as a participant under the scheme.
(..........................)
Date: Signature of the Investor/Customer
Certified that the particulars furnished above are correct as per our records.
(Bank's Stamp)
(..........................)
Date: Signature of the Authorised Official of Bank
