| ELECTRONIC CLEARING SERVICE |
| MANDATE FORM |
| Investor's opting to receive Dividend Payments through Credit Clearing Mechanism |
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a) Folio No.
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b) DP ID *
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c) Client ID *
(* applicable if shares are held in Electronic Form)
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| 2
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Investor's Name
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| 3
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Particulars of Bank Account
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a) Bank Name
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b) Branch Address
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c) 9-Digit Code Number of the Bank and
branch appearing on the MICR
cheque issued by the Bank
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d) Account type (SB/Current/Cash Credit)
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e) Account No. (as appearing on the cheque book)
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| 4
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Date of Effect
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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 of me as a participant under the scheme. |
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| Date :
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(Signature of the Investor)
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| Certificate of the Investor's Bank |
| Certified that the particulars furnished above are correct as per our records. |
| (Signature of the Authorised Official from the Bank) |
Bank Stamp :
Date :
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(Note : In lieu of the bank certificate to be obtained as above, Investor can attach a blank "cancelled" cheque or a photocopy thereof) |
