NACH DEBIT MANDATE FORM IDFC BANK
Tick () UMRN Date
CREATE D D M M Y Y Y Y
MODIFY Sponsor Bank Code IDFB0000001 Utility Code NACH00000000020993
CANCEL I/We hereby authorize TATA POWER -DDL to debit Tick () CA CC SB-NRE SB-NRO Other
Bank a/c number
with Bank IFSC or MICR
an amount of Rupees `
FREQUENCY Monthly Qtly H.Yrly Yrly As & when presented DEBIT TYPE Fixed Amount Maximum Amount
Reference 1 Phone No.
Reference 2 Email ID
I have understood that the bank, where I have authorised the debit, may levy onetime mandate processing charges as mentioned in their latest schedule of charges published by the bank.
PERIOD
CB-WB/177/10-2015/2000
From
To
1 2 3
OR Until Cancelled
This is to confirm that the declaration has been carefully read, understood and made by me/us.
I am authorizing the User entity/Corporate to debit my account.
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 the debit.
Instruction to fill Mandate
1. UMRN is auto generated during mandate creation and is mandatory to be updated during amendment and cancellation of mandate
(Maximum Length – 20 Alpha Numeric Characters)
2. Date is in DD/MM/YYYY format.
3. Sponsor bank IFSC/MICR code left padded with zeroes where necessary. (Maximum length- 11 Alpha Numeric Characters).
4. Utility Code of the Service Provider. (Maximum length- 18 Alpha Numeric Characters).
5. Name of Service Provider.
6. Tick on box to select type of action to be initiated.
7. Tick on box to select type of account to be affected.
8. Customer legal account number (Maximum length- 35 Alpha Numeric Characters).
9. Name of Bank.
10. IFSC/MICR code of customer bank (Maximum length- 11 Alpha Numeric Characters for IFSC & 9 Numeric for MICR code.).
11. Amount payable for service or maximum amount per transaction that could be processed in words.
12. Amount in figures similar to the amount mentioned in words. (Maximum length- 13 digit Numeric in paise).
13. Service Provider generated consumer reference number.
14. Service Provider generated Scheme / Plan reference number.
15. Tick on box to select frequency of transaction.
16. Validity for mandate with dates in DD/MM/YYYY format.
17. Name of Customer/s and signature/s as well as seal of company (where required) (Maximum length- 40 Alpha Numeric Characters)
18. Undertaking by customer.
19. Telephone Number of the customer.
20. Mail ID of customer