Electronic Clearing Service (Credit Clearing) Mandate Form

(Investor(s)’s option to receive redemption proceeds and interest payments through Credit Clearing Mechanism)

1) Investor(s)’s name & address :
2) (a) Member ID No./BLA No. :
(b) PAN/GIR No.* :
(c) Telephone No./Mobile No./E-mail ID:
3) Particulars of Bank account
A Name of the Bank :
B Name of the branch :
Address :
Telephone No. :
C 9-Digit code number of the bank and branch
appearing on the MICR cheque issued by the bank:
D Type of the account (Savings, Current or Cash Credit)
with code (10/11/13) :
E Ledger and Ledger folio number:
F Account number (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/We 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/We would not hold the user institution responsible. I/We have read the
option invitation letter and agree to discharge the responsibility expected of us as a
participant under the scheme.
Date: (.....................................)
Signature(s) of the Investor(s)
(In case of joint holdings, all the investors, whose signatures are registered with
PDOs, should sign here)
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Certified that the particulars furnished above are correct as per our records.
Bank’s Stamp:
Date: (.................................)
Signature of the authorised
official of the Bank
*: Compulsory for investors due to receive maturity proceeds exceeding Rs. One lakh