(MODEL MANDATE FORM)
C.9-DIGIT CODE NUMBER OF
THE BANK & BRANCH :
(Appearing on the MICR cheque
issued by the bank)
(S.B. Account/Current Account or
Cash Credit with Code10/11/13)
(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).
4.DATE OF EFFECT:
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 responsibility expected 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.
Signature of the Authorised
Official from the Bank.