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FORMAT OTS-F-12 RTGS/ NEFT MANDATE AUTHORISATION FORM 1. Supplier s / Vendor s Name 3A. Supplier s Code 3B. Supplier s PAN Number Quoting PAN No* in all the e-returns has become 100 mandatory w. e. f* 14-02-2008 hence ensures to fillup this and also send a photocopy of PAN duly self-attested* If there is any difference between the name given in the supplier s name and name given in the PAN card then a note to explain the reason for the difference and the correlation between both. Door No* Street Location District City State PIN M 7. Name of the Bank 8. Bank Branch Postal Address 9. RTGS/NEFT - Code of the Branch RTGS NEFT RTGS - Real Time Gross Settlement NEFT - National Electronic Fund Transfer. These IFSC Codes are unique numbers of each Branch Indian Financial Services Code. For some Branches both the codes are the same and some Banks may maintain one Code No* for RTGS and another Code No* for NEFT. Hence please fill-up both the rows even if it is the same. 10. Nature of the Account Tick whichever is applicable put x mark for the balance two accounts Saving Bank Account Cash Credit Account Current Account 11. Bank Account Number of the Supplier st Fill up from the 1 column* For the balance left out blank columns please mention x mark. We hereby declare that the particulars given above are correct and complete. If the transaction is delayed for reasons of incomplete or incorrect information we would not hold MDL responsible. Date Supplier s Seal Authorized Signature of the Supplier Certified that the particulars as per Serial Numbers 2 7 to 11 are correct as per our records. Supplier s PAN Number Quoting PAN No* in all the e-returns has become 100 mandatory w. e. f* 14-02-2008 hence ensures to fillup this and also send a photocopy of PAN duly self-attested* If there is any difference between the name given in the supplier s name and name given in the PAN card then a note to explain the reason for the difference and the correlation between both. Door No* Street Location District City State PIN M 7. Name of the Bank 8. Bank Branch Postal Address 9. Door No* Street Location District City State PIN M 7. Name of the Bank 8. Bank Branch Postal Address 9. RTGS/NEFT - Code of the Branch RTGS NEFT RTGS - Real Time Gross Settlement NEFT - National Electronic Fund Transfer. RTGS/NEFT - Code of the Branch RTGS NEFT RTGS - Real Time Gross Settlement NEFT - National Electronic Fund Transfer. These IFSC Codes are unique numbers of each Branch Indian Financial Services Code. For some Branches both the codes are the same and some Banks may maintain one Code No* for RTGS and another Code No* for NEFT. These IFSC Codes are unique numbers of each Branch Indian Financial Services Code. For some Branches both the codes are the same and some Banks may maintain one Code No* for RTGS and another Code No* for NEFT. Hence please fill-up both the rows even if it is the same. 10. Nature of the Account Tick whichever is applicable put x mark for the balance two accounts Saving Bank Account Cash Credit Account Current Account 11.

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