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Ecs Form

This document is an Electronic Clearing Service (Debit Clearing) Mandate Form for authorizing a bank to debit an account for payments to Axis Bank Limited. It requires the applicant to provide their account details, scheme information, and a declaration of accuracy. The form must be submitted in three copies, with a blank cancelled cheque attached for verification purposes.

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141 views1 page

Ecs Form

This document is an Electronic Clearing Service (Debit Clearing) Mandate Form for authorizing a bank to debit an account for payments to Axis Bank Limited. It requires the applicant to provide their account details, scheme information, and a declaration of accuracy. The form must be submitted in three copies, with a blank cancelled cheque attached for verification purposes.

Uploaded by

enhance legal
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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FORM NO.

E – 5
Utility Code

Loan Account No.

Loan Applicant Name:

ELECTRONIC CLEARING SERVICE (DEBIT CLEARING) MANDATE FORM


(Please fill the form in Block letters)
The Manager Copy to the User Company
Bank Name: Name : AXIS BANK LIMITED
Branch Name: Address : Central Asset Hub (CAH)
Address: Building no - 1, Gigaplex,
Floor no - 4, Plot No. I.T 5,
MIDC, Airoli Knowledge Park,
Telephone No: Airoli, Navi, Mumbai,
Pin code - 400708

I hereby authorize you to debit my account for making payment to 'Axis Bank Limited' through ECS (Debit) clearing as per the details
given as under:

A. Name of the Account Holder


( As per Bank’s records)

B. Account Number
(Operative a/c No.)

C. Account Type
Savings A/c Current A/c Cash Credit Others: ___________

D. MICR – 9 digit MICR Code


number of bank & branch

E. Ledger No/ Ledger Folio No.

Date of effect
Name of the Scheme Periodicity Amount of Number of
Cycle Date
(PRODUCT) (M/Bim/Qty/etc.) Installment upto Installments
From To

I hereby declare that the Bank Account 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 the responsibility expected of me as a participant under the scheme.

Date: - ______________ _____________________________________________________


Signature of Account Holder (s)

(Please affix a rubber stamp in case of companies, proprietorships, partnerships etc)

(For office use only)


Certified that the Bank Account particulars furnished above are correct as per our records & we have updated our records.

______________ _____________________________________________________
(Bank Stamp) (Signature of authorized bank official)

Date: ____________

Note: - 1. Mandate to be obtained in 3 Copies, Original for Bank, One for User Co and other for Customer
2. Please attach a blank cancelled cheque issued by your bank for verifying the accuracy of the MICR Code,
Transaction Code, A/C No and Signature.

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