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Ard number. 3. Please fill all the fields (all fields on both the forms are mandatory). UMRN FORM 1 DATE Utility Code: CITI0000004 TICK( ) Sponsor Bank Code: CREATE MODIFY CANCEL I/We hereby authorize Citibank N.A. to debit (tick ) CITI00368000023446 SB/CA/CC/SB-NRE/SB-NRO/OTHER Bank a/c Number IFSC With Bank or MICR *an amount of Rupees FREQUENCY Mthly Qtly H-Yrly Yrly As & when presented DEBIT TYPE *Reference 1 MAX Amt Phone No. Reference 2 FIXED Amt Email ID I agre.

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