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pcdacc.gov.in

' i r] NEFT MandateForm l. VendorDetails A. Nameof Firm: B. Nameof contactperson: C. Address: D. ContactNo. : 2. Particulars of Bankaccount A. AccountTitle: B. Nameof theBank: C. Nameof thebranch: Address: Telephone No. : D. I I digit IFSCCode: E. 9-DigitMICR codenumberof thebankandbranch appearing on the MICR chequeissuedby thebank: F. Typeof theaccount( ,Currentor CashCredit): G. Accountnumber(asappearingon the chequebook): ( pleaseattacha blankcancelled chequeor photocopy ofa cheque). I herebydeclarethattheparticulars givenabovearecorrectandcomplete. Ifthe transactionis delayedor not effectedat all for reasonsof incompleteor incorrectinformation,I wouldnot hold the userinstitutibnresponsible.

Created Date: 7/13/2009 1:45:07 PM

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Transcription of pcdacc.gov.in

1 ' i r] NEFT MandateForm l. VendorDetails A. Nameof Firm: B. Nameof contactperson: C. Address: D. ContactNo. : 2. Particulars of Bankaccount A. AccountTitle: B. Nameof theBank: C. Nameof thebranch: Address: Telephone No. : D. I I digit IFSCCode: E. 9-DigitMICR codenumberof thebankandbranch appearing on the MICR chequeissuedby thebank: F. Typeof theaccount( ,Currentor CashCredit): G. Accountnumber(asappearingon the chequebook): ( pleaseattacha blankcancelled chequeor photocopy ofa cheque). I herebydeclarethattheparticulars givenabovearecorrectandcomplete. Ifthe transactionis delayedor not effectedat all for reasonsof incompleteor incorrectinformation,I wouldnot hold the userinstitutibnresponsible.

2 I. havereadthe option invitationletterandagreeto discharge theresponsibilityexpectedofme asa participantunder thescheme. (..). Signature of AccountHolder Date: certifiedthat the particularsfurnishedabovearecorrectasper our records. Signature of theauthorisedBankManagerWith RubberStamp Date.


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