Annexure 2
Electronic Clearing Service (Credit Clearing) Form
(Investors/Customers/Vendors option to receive payments through Credit Clearing Mechanism)
Particulars of Investor/Customer/Vendor
Name of Investor/Customer/Vendor
(As appears on Pass Book of bank)
Address of Investor/Customer/Vendor
Contact Details of Investor/Customer/Vendor
(Office number, phone no. and e-mail)
PAN No. of Investor/Customer/Vendor
Particulars of Bank Account
Bank Name
Branch Name
Address of Bank
Telephone No. of Bank
Account Type
(S.B. Account / Current Account or any other)
Account Number
(as appears on the Cheque Book)
MICR No.
(9 digits code number of the Bank and Branch appearson
the cheque issued by the bank)
IFS Code of Bank
I hereby declare that the particulars given above are correct and complete. If the transaction is delayed or not effected at allfor 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.
Certified that the particulars furnished above are correct as per our records.
Date Date
Signature of Investor/Customer/Vendorwith Signature of Authorized bank official withcommon
common seal of the organization seal