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ra Ecos ‘ACH MANDATE FORM Wieundersandyeurwend UMN oatel Tick sponsor sank code [H [D[F]¢]0] 0] 0 [o[0]2 | 5] usltycode[H]o] F [c]o[o[o]a|7]o]o]o]olo]1|1]o]s Geste le] \yweherebyauthore [HOFC Bank Limited ]o Debit Tick ¥) []s8 [ea [Jee L]se-nre [J snro [Jothers feancet x] Sank Ac Number with bank wesc an amount of Rupees Frequency (2 mthiy] atly CO) vty C1 ely] As & when Presented Debit Type faximum Amount Reference 1 PhoneNo, Reterence 2 emaiio From » KXKXEEKE or [Z] unt cancetes : 7 ; “is coin at eolaabn has boon carl rb, nese mae by meus. am autora te Us rity Copernic bse he Icons os ped Asie ym. Ihave ancestors nat adhered can sn is marcy sproprany cormuncg te caraaten anertrecueso Use ey [creat che bank wt ha auberaed IMPORTANT INSTRUCTIONS FOR FILLING ACH MANDATE FORM Following fields need to be filled mandatorily in Black and Capital Letters : Please mention date in format dd/mm/yyyy Please tick bank account type viz SB for Saving Bank, CA for current account Bank account number valid for ECS/RTGS/NEFT as ‘appearing in account statement. Bank and Branch name where account is held. IFSC/MICR code valid for ACH as per account stalemen/Cheque. ‘Amount on mandate in words and figure Reference No 1 ~ Mention Loan account number Reference no2: Mention Loan type Mobile number &¢ mail ID Period: From -Select Start date in ddimmiyyyy format EMI date, Period: - To nottto be filled Signature — as per bank records ensure there is no variation in signature from banks records Name: As per Banks records in full and in Capital. In case of Cooperative Banks please check with your bank on IFSC/MICR valid for ACH purposes, 3. InCase of account type —Cash Credit/OD please check with your bank on acceptance of ACH debit mandate on these account type. 4. Please ensure no overwriting on mandate form, 5. Please donotwrteltick on following fields: 1,7,6,14,15, 6. Please take printout on good quality A4 paper, and tear across the line marked with scissor. 7. Form tobe submitted along with copy oflatest bank accountstatementto nearest retail Asset Branch,

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