Get Form No E 5

FORM NO. E-5 Appendix VIII Electronic Clearing Service Credit Clearing Model Mandate Form Investor/customer s option to receive payments through Credit Clearing Mechanism Name of the Scheme and the periodicity of payment No. 2 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 S.B. Current or Cash Credit with code 10/11/13 E F Ledger and Ledger folio number 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 Date of effect 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. Signature of the Investor/Customer Date Certified that the particulars furnished above are correct as per our records. Current or Cash Credit with code 10/11/13 E F Ledger and Ledger folio number 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 Date of effect 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. 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. I have read the option invitation letter and agree to discharge the responsibility expected of me as a participant under the scheme. Signature of the Investor/Customer Date Certified that the particulars furnished above are correct as per our records. Current or Cash Credit with code 10/11/13 E F Ledger and Ledger folio number 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 Date of effect 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.