ECS Proforma

FormE-5

ELECTRONIC CLEARENCE SERVICE (CREDIT CLEARING)

MANDATE FORM

OFFICER’S OPTION TO RECEIVE SALARY THROUGH CREDIT CLEARING MECHANISM

1. Name of the Officer                     :

2. Designation                                     :

3. Bank’s Name                                   :

4. Branch Name                                  :

5. Address                                             :

6. 09-Digit Code number of the      :

Bank& Branch appearing on the

MICR cheque issued by the bank.

7. Account Type (Saving/Current):

    With code 10/11/12

8. Account No. (As appearing on    :

    cheque book)

9. Date of Effect                                 :

I hereby declare that the particulars given above are correct and complete.

(Sig. of Officer)

* Note: Please attach a blank cancelled cheque or photocopy of a cheque issued by your bank for verification of the above particulars.