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.
