MANDATE FORM
ELECTRONICCLEARINGSERVICE{CREDITCLEARING)/REAL TIME GROSS
SETTLEMENT(R.TGS}J'ACl1.11'YFOR RECEtYfNG P/1.YMltNTS
A. DETAILSOFBANKACCOUNTHOLDER:-
NAMEOFTIIBACCOUNTHOLDER
COMPLETE CONTACT: AOORES-S·
TELEPHONE NUMBER/FAX/MAIL
B. BANKACCOUNTDETAILS
BANKNAME
I
UNION. BANK' OF INDtA
I BRANCH NAME WITH COMPLETE ~AK5Hm1Pvl2All1 SRANCH
IAOOR!SS, TELEPHONENUMllERAND ·Gts L- mEDid¾L COl.-t..E.CnE comPWNi>,
I EMAIL RA.TAl-fMV NOl<Y, f=,G, Di.ST, 53,3 2-c; Lf
I WHETHER THE BANK IS COMPUTERISED?
•
· '-/ES
, v,:,·mo ts '"' ·Tld;O\ , ~'Y\K
WHETHER THE BANK IS RTGS ENABLED?
If YES, THEN WHAT IS TI:1£.BRANCH'S- RTGtS Et~A-C3L-ED
IFSCCODE f F.sc - Ul?IN o'2>>5 t52
NEPT
TYPE OF BANKACCOUN
(SBICURMNT/CASH CREDIT.)
I ~~~E:-BANKACCOUNTNUMBE.R:
I 5 / 512.0 I 000 I 661
MICR CODE OF BANK
53302 6060
OAtEOFEF FECT:-15- 8 - 2.o 25
t b"eY~- declare that t&c particulars gi~cn above arc c~rrcct and complete. If the transaction is delayed
or not effected at all for reasons of incomplete or incorrect 1.w~uld not hold the user Institutioa:a.
rcsponsiolc-.- J. have read· the optioJT inv.itat.i'Cffl retrcr- and' agree to discharge responsibility expected of me
as a participant under the scheme.
(
)
f '3 - oS -2-o 2.5
~
Date:
.Y·flt.X
S1gnanireireusto , ·
Certified that the particulars furnished above are correct as per our records.
fB-ank's SmmpJ (
Date 18-os - 2-01..s
Please attach• photocopy of claeqae a1eeg witltthe nrlfkatlon obtabftd' from tlie bank.
fu cue your Bank ~ pre~ntly no~ "RT~S _Enabled", then upon its up gradation to "RTGS Enabled"
branch, please subJlllt the mfonnation again an the above piofonna. to tl1e Department at ca"'l' . t·
1es . ,l
