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BAJAJ FINANCE LTD. 4th Floor Bajaj Finserv Corporate Office Off Pune-Ahmednagar Road Viman Nagar Pune 411 014 Maharashtra Tel No. 020 -30405060 / 30405261 / 30405221 DIRECT DEBIT /ECS DEBIT CLEARING MANDATE FORM The Manager Bank Name Branch Address Branch City Pin Code Please write the address of the bank s branch as per the cancelled cheque attached. I hereby authorize you to debit my account for making payment to BAJAJ FINANCE LIMITED through Direct Debit / ECS Debit clearing as per the details given as under A. 9 DIGIT MICR CODE NUMBER OF THE BANK BRANCH Please write MICR Code of 9 digit number appearing after cheque number in cancelled Cheque. Confirm MICR code with your banker. MICR Code starting and / or ending with 000 are not valid for ECS B. ACCOUNT TYPE Savings Account/ Current Account / Cash Credit C. LEDGER NO. / LEDGER FOLIO NO. D. ACCOUNT NO. If Bank A/c No* is changed due to core banking confirm with the Bank write correct A/c* The A/c no written here should match with cancelled cheque attached Name of Scheme Date of Effect DD/MM/YYYY Periodicity M/BiM/Qly/etc* Amount of Installment with Upper Limit Valid up to E* DATE OF EFFECT DD/MM/YYYY F* NAME OF ACCOUNT HOLDER AS IN BANK RECORDS NAME OF THE JOINT ACCOUNT HOLDER IF ANY NAME OF THE BORROWER CONTACT NUMBER OF THE ACCOUNT HOLDER Mobile Number / Residential Telephone Number EMAIL ID OF THE ACCOUNT HOLDER I 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 would not hold the user institution responsible. I have read the option invitation letter and agree to discharge the responsibility expected of me as a participant under the scheme. Date Signature of Account Holder Signature of Joint Account Holder if any Signature should match with the signature in Bank Records Certified that the bank A/c details like A/c Number A/c Holder Name A/c Type and MICR code are correct as per our records. Bank s Stamp Loan Account Number to be filled by BFL Mandate to be obtained in 2 copies from customer Signature of the Authorized official from the Bank. 9 DIGIT MICR CODE NUMBER OF THE BANK BRANCH Please write MICR Code of 9 digit number appearing after cheque number in cancelled Cheque. Confirm MICR code with your banker. MICR Code starting and / or ending with 000 are not valid for ECS B. Confirm MICR code with your banker. MICR Code starting and / or ending with 000 are not valid for ECS B. ACCOUNT TYPE Savings Account/ Current Account / Cash Credit C. LEDGER NO. / LEDGER FOLIO NO. D. ACCOUNT NO. ACCOUNT TYPE Savings Account/ Current Account / Cash Credit C. LEDGER NO. / LEDGER FOLIO NO. D. ACCOUNT NO. If Bank A/c No* is changed due to core banking confirm with the Bank write correct A/c* The A/c no written here should match with cancelled cheque attached Name of Scheme Date of Effect DD/MM/YYYY Periodicity M/BiM/Qly/etc* Amount of Installment with Upper Limit Valid up to E* DATE OF EFFECT DD/MM/YYYY F* NAME OF ACCOUNT HOLDER AS IN BANK RECORDS NAME OF THE JOINT ACCOUNT HOLDER IF ANY NAME OF THE BORROWER CONTACT NUMBER OF THE ACCOUNT HOLDER Mobile Number / Residential Telephone Number EMAIL ID OF THE ACCOUNT HOLDER I hereby declare that the particulars given above are correct and complete. .