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Mandate Form

This document is a mandate form containing details for fund transfers. It includes the customer's name and address, bank account details like account number and IFSC/NEFT codes, date of effect, and signatures agreeing to the terms. The customer provides banking information and declares it is correct. The bank certifies the details match their records.

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472 views1 page

Mandate Form

This document is a mandate form containing details for fund transfers. It includes the customer's name and address, bank account details like account number and IFSC/NEFT codes, date of effect, and signatures agreeing to the terms. The customer provides banking information and declares it is correct. The bank certifies the details match their records.

Uploaded by

kanusri
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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MANDATE FORM

1. INVESTOR/CUSTOMER’S NAME :
WITH COMPLETE ADDRESS,
TEL/FAX NO AND EMAIL ID

2. PARTICULARS OF BANK ACCOUNT

A. BANK NAME :

B. BRANCH NAME :
ADDRESS :

TELEPHONE NO. :

C. 9-DIGIT CODE NUMBER OF THE :


BANK & BRANCH APPEARING
ON THE MICR CHEQUE ISSUED
BY THE BANK.

D. ACCOUNT TYPE :

E. LEDGER NO. /LEDGER FOLIO NO. :

F. ACCOUNT NUMBER (AS APPEARING :


ON THE CHEQUE BOOK)
(In lieu of the bank certificate to be obtained as under, please attach a blank cancelled cheque or photocopy of a cheque or front
page of your savings bank passbook issued by your bank for verification of the above particulars)

3. DATE OF EFFECT :

INFORMATION FOR PAYMENT THROUGH RTGS OR NEFT

G. IFSC CODE :

H. NEFT CODE :

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 the responsibility expected of me as participant under
the scheme.

……………………………
Signature of the
Investor/Customer
DATE: with Company’sStamp

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

Bank’s Stamp:
SIGNATURE OF THE
AUTHORISED/OFFICIALWITH PHONE NO.
FROM THE BANK.

DATE:

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