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Customer SI Debit Authorisation Form: Date: - Loan Agreement No

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Customer SI Debit Authorisation Form

Date : __________________

Loan Agreement No : _______________


To,

The Branch Manager,


HDFC Bank Ltd,
__________________

Dear Sir/Madam,

I have taken a _______________ loan from HDFC Bank and would like to avail of the Standing Instruction
facility offered by your bank to make repayments towards my loan.

I, therefore, request you to accept this mandate to debit my Account Number

towards recovery of repayment dues of my loan account as per due dates & terms and conditions
mentioned in the loan agreement schedule or as per revised instructions basis requirements as
communicated from my end in line with the Bank’s policy.

I undertake to maintain sufficient balances to cover the Loan Repayment Dues (and charges, if any) on the
stipulated due dates. I also understand that failure to repay my loan amount through this standing
instruction shall be treated as a default in repayment of dues and all charges/penalties/levies as covered by
the agreement will hold good towards the non payment of obligations.

Please treat this as an irrevocable communication as an authorization to debit my account every month with
the required amounts towards the repayment of my loan.

In the event of the above account getting closed/transferred for any reason, I/We will intimate to the Bank
the new account opened with the bank to debit the Loan Repayment Amounts as per the agreement.
Further, I/We undertake the responsibility to provide the fresh set of Mandate and security PDCs for such
new account, as per terms of the agreement in lieu of existing instructions.

I also understand and accept that the Bank will have the right to set-off, without prior intimation to me, the
available balances in the designated account for recovery of overdue installments and/or charges (if any) in
the loan account.

Thanking you,
Yours truly,

(Signature of Account Holder) (Name of the Account Holder)


…………………………………………………………………………………………………………………………………………..
VERIFIED
O Customer Account Number
O Customer Signature
O Customer Account Status is Active
O Mode of Operation Verified
(Seal and Signature of HDFC Bank Official)

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