Page 34 - Plastics News September 2018

MSME

Annexure-VIII
MANDATE FORM
Electronic Clearing Service (Credit Clearing)/Real Time Gross Settlement (RTGS)
facility for receiving payments.
A. Details of Accounts Holders:-
Name of Account Holder

Complete Contact Address

Telephone Number/Fax/E-mail

B. Bank Account Details:-
Bank Name

Branch Name with Complete Address,
Telephone No. and E-mail
Whether the Branch is computerized?

Whether the Branch is RTGS enabled? If
yes then what is the Branch’s IFSC Code
Is the Branch also NEFT enabled?

Type of Bank Account (SB/Current/Cash
Credit)
Complete Bank Account No. (Latest)

MICR Code of Bank

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 use Institution
responsible. I have read the option invitation letter and agree to discharge responsibility expected of me as a
participant under the Scheme.

Signature of Customer
Date:

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

(Bank’s Stamp)
Date:
Signature of Customer

1. Please attach a photocopy of cheque along with the verification from the bank.
2. In case you Bank Branch is presently not “RTGS enabled”, then upon its upgradation to “RTGS
Enabled” branch, please submit the information in the above proforma to the Department as earliest.

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