® 1 2

UMRN Date D D M M Y Y Y Y
3 4
(tick
P)
7 Sponsor
Bank
Code Y E S B 0 0 0 0 0 0 1 Utility Code Y E S B 0 0 1 7 1 0 0 0 0 0 5 5 0 4
CREATE P I/We
hereby
authorize

5
to
debit
(tick
P)
6
SMC Global Securities Limited SB
/
CA
/CC
/
SB-NRE
/
SB-NRO
/
Other
MODIFY X
8
CANCEL X Bank
Account
Number
9 10 11
With
Bank IFSC or
MICR
12 13
an
amount
of
Rupees (Name
of
Customers
Bank) `
X Mthly X Qtly X H-Yrly X Yrly as
&
when
presented 15DEBIT
TYPE
14 FREQUENCY P X Fixed
Amount P Maximum
Amount
16 18
Reference-1 Phone
No
17 19
Reference-2 Email
ID
I agree for the debit of mandate processing charges by the bank whom I am authorizing to debit my account as per latest schedule of charges of the bank.
20 PERIOD

From D D M M Y Y Y Y
(12)
*
Signature
of
the
account
holder
__________________________ (8)
*__________________________
Signature
of
the
account
holder (8)
*__________________________
Signature
of
the
account
holder
To X X X X X X X X
Until
Cancelled Name
of
the
account
holder Name
of
the
account
holder Name
of
the
account
holder
P __________________________ __________________________ __________________________
• This is to confirm that the declaration has been carefully read, understood & made by me/us. I am authorizing the User entity/Corporate to debit my account, based on the instructions as agreed and signed by me.
• I have understood that I am authorized to cancel/amend this mandate by appropriately communicating the cancellation/amendment request to the User entity/corporate or the bank where I have authorized debit.
MANDATE
INSTRUCTION
(Refer
Instruction
over
leaf
before
filling)

® 1 2
UMRN Date D D M M Y Y Y Y
3 4
(tick
P)
7 Sponsor
Bank
Code H D F C 0 0 0 0 0 6 0 Utility Code Y E S B 0 0 7 0 9 0 0 0 0 2 8 6 6 1
CREATE P I/We
hereby
authorize

5
to
debit
(tick
P)
6
ICCL SB
/
CA
/CC
/
SB-NRE
/
SB-NRO
/
Other
MODIFY X
8
CANCEL X Bank
Account
Number
9 10 11
With
Bank IFSC or
MICR
12 13
an
amount
of
Rupees (Name
of
Customers
Bank) `
15DEBIT
TYPE
14 FREQUENCY X Mthly X Qtly X H-Yrly X Yrly P as
&
when
presented X Fixed
Amount P Maximum
Amount
16 18
Reference-1 Phone
No
17 19
Reference-2 Email
ID
I agree for the debit of mandate processing charges by the bank whom I am authorizing to debit my account as per latest schedule of charges of the bank.
20 PERIOD

From D D M M Y Y Y Y
(13)
*
Signature
of
the
account
holder
__________________________ (9)
*__________________________
Signature
of
the
account
holder (9)
*__________________________
Signature
of
the
account
holder
To X X X X X X X X
Until
Cancelled Name
of
the
account
holder Name
of
the
account
holder Name
of
the
account
holder
P __________________________ __________________________ __________________________
• This is to confirm that the declaration has been carefully read, understood & made by me/us. I am authorizing the User entity/Corporate to debit my account, based on the instructions as agreed and signed by me.
• I have understood that I am authorized to cancel/amend this mandate by appropriately communicating the cancellation/amendment request to the User entity/corporate or the bank where I have authorized debit.
MANDATE INSTRUCTION (Refer Instruction over leaf before filling)

* Signature should be same as in bank record.

*Bank may levy charges for NACH Mandate Registration.

C2