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DB_ECS_Mandate FOrm

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DB_ECS_Mandate FOrm Powered By Docstoc
					Account Registration for ECS (Moving
Money From Customer’s Other Bank A/c’s)
To be filled in by the Bank Official:
Date of Receipt:
Officer Code:


                                      FIELDS WITH * (STAR) ARE COMPULSORY. Please fill all the details in CAPITAL LETTERS and BLACK INK only.

Date:
To,
The Manager ,
* Other   Bank Name
* Branch   Name
* Branch   Address
Personal Details
* Customer Name:
                               Mr./ Ms./ Dr.                                              Applicant Name

Authorization Details
I hereby authorize you to debit my account for making payment to               _                                                 _
(User Co.Name) through ECS (Debit) clearing as per the details given as under.
A. 9-DIGIT CODE NUMBER OF
THE BANK & BRANCH
                                                       (Appearing on the MICR cheque issued by the bank)
B. ACCOUNT TYPE                                Savings Account                 Current Account                           Cash Credit
                                                           (S.B. Account/Current Account or Cash Credit)
C. ACCOUNT NUMBER
D. STARTING DATE
Document Check List          (I have attached along with this application the following documents)

Cancelled Cheque of the Other Bank Account
Declaration
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.


                                                                                                           Signature of the Customer
Verification by Bank Official
Certified that the particulars furnished above are correct as per our records.

Date:                                                                                                         Signature of the Official

				
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posted:2/21/2010
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