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Mandate Form: Bank

This document is a mandate form authorizing Mahanagar Telephone Nigam Limited (MTNL) to debit a subscriber's bank account for payment of telephone bills through electronic clearing service. The subscriber provides their name, telephone number, bank account details including name, branch, MICR and account numbers. The subscriber authorizes MTNL to raise debits on their regular monthly/bi-monthly telephone bills electronically from the specified bank account. The bank certifies the provided bank details match their records.

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Jinal Jyoti Joshi
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135 views2 pages

Mandate Form: Bank

This document is a mandate form authorizing Mahanagar Telephone Nigam Limited (MTNL) to debit a subscriber's bank account for payment of telephone bills through electronic clearing service. The subscriber provides their name, telephone number, bank account details including name, branch, MICR and account numbers. The subscriber authorizes MTNL to raise debits on their regular monthly/bi-monthly telephone bills electronically from the specified bank account. The bank certifies the provided bank details match their records.

Uploaded by

Jinal Jyoti Joshi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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BANK COPY

MAHANAGAR TELEPHONE NIGAM LIMITED


(A Govt.of India Undertaking)
Office of Executive Director, K.L. Bhawan, New Delhi-110050
ELECTRONIC CLEARING SERVICE (DEBIT CLEARING)
MANDATE FORM
SUBSCRIBER'S-AUTHORISATION TO PAY TELEPHONE BILLS THROUGH
ELECTRONIC DEBIT CLEARING MECHANISM

(FOR OFFICIAL USE) FORM NO.

Date of FER T. FED PC FED


DLR No. AREA BC
Rec. No. Date Date

1 SUBSCRIBER'S NAME :__________________________________________________________________

2.TELEPHONE NUMBER :
(if more telephone nos. attach separate list signed by competent authority)

3. C.A. NO. :
(Please attach the Photocopy of the last paid bill.)

4. PARTICULARS OF BANK ACCOUNT:


i) BANK NAME :_____________________________________________________________________
ii) BRANCH NAME :___________________________________________________________________
iii) 9-DIGIT CODE NUMBER OF THE BANK AND BRANCH
APPEARING ON THE MICR CHEQUE ISSUED BY THE BANK :
(Please attach the photocopy of a cheque or a cancelled cheque leaf)
iv) ACCOUNT TYPE (S.B. ACCOUNT /CURRENT
ACCOUNT/ CASH CREDIT) WITH CODE 10/11/13 : SB Current Cash Credit
v) LEDGER FOLIO NO.(if appearing on the cheque book) :________________________________________
vi) ACCOUNT NUMBER (as appearing on the cheque book) :_______________________________________
vii) NAME OF THE ACCOUNT HOLDER :________________________________________________________

5. UPPER LIMIT (if any) :___________________________________________________________________


I/We being the subscriber(s) of above telephone number(s) hereby express my/our willingness to settle the payment of
regular month/bi-monthly telephone bills of the telephone connections referred to above through participation in E.C.S.
of National Clearing cell of Reserve Bank of India,delhi and hereby authorise Accounts Officer (ECS), M.T.N.L.Delhi to
raise the debits on such regular monthly/bi-monthly telephone bills as referred to above through this scheme
electronically for adjustment against Debit in my/our above Account No.

I/We have given today standing instructions to my/our Bank.

_____________________ ______________________
Signature of A/C Holder Signature of Subscriber
Name in Block Letters _____________________ Name in Block Letters_________________________
(in case name of Subscriber differs that of A/c holder) Add ______________________________________
_______________________________________

Authorised Signatory of the Bank


Bank's stamp
Certified that the particulars furnished regarding bank
are correct as per our record.

Note : After verification from the bank MTNL Copy may please be sent to A.O. (ECS) Room No. 325,
K.L. Bhawan New delhi-110050 Tele .No.:23326066 Toll. Free No.: 1600113399 Fax No. 23353921

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