ELECTRONIC CLEARING SERVICE | |||
MANDATE FORM | |||
Investor's opting to receive Dividend Payments through Credit Clearing Mechanism | |||
1 | a) Folio No. | : | |
b) DP ID * | : | ||
c) Client ID * (* applicable if shares are held in Electronic Form) |
: | ||
2 | Investor's Name | : | |
3 | Particulars of Bank Account | : | |
a) Bank Name | : | ||
b) Branch Address |
: | ||
c) 9-Digit Code Number of the Bank and branch appearing on the MICR cheque issued by the Bank | : | ||
d) Account type (SB/Current/Cash Credit) | : | ||
e) Account No. (as appearing on the cheque book) | : | ||
4 | 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 of me as a participant under the scheme. |
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Date : | (Signature of the Investor) | ||
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) |