Office of Chief General Manager,K.L.Bhawan , New Delhi –110050
ELECTRONIC CLEARING SERVICE (DEBIT CLEARING)
MANDATE FORM
SUBSCRIBER AUTHORISATION TO PAY TELEPHONE BILLS THROUGH
ELECTRONIC DEBIT CLEARING MECHANISM
1.) SUBSCRIBER’S NAME: ---------------------------------------------------------
| 2.) TELEPHONE NUMBER : | |
|
(if more telephone nos. attach separate list signed by competent authority)
| 3. A.) C.A. NO. | |
|
|
Please attach The Photocopy of last paid Bill |
||
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4.) PATICULARS OF BANK ACCOUNT :
i) BANK NAME :---------------------------------------------------------------------
ii) BRANCH NAME :----------------------------------------------------------------
iii) 9-DIGIT CODE NUMBER OF THE BANK AND BRANCH
APPEARING ON THE MICR CHEQUE ISSUED BY THE BANK ----------------------
(PLEASE ATTACH THE PHOTOCOPY OF A CHEQUE OR A CANCELLED CHEQUE LEAF)
| iv) ACCOUNT TYPE (S.B.ACCOUNT /CURRENT ACCOUNT /CASH CREDIT) WITH CODE 10/11/13 |
 |
 |
 |
v) LEDGER FOLIO NO.
( IF APPEARING ON THE CHEQUE
BOOK):--------------------------------------------------------
vi) ACCOUNT NUMBER
(AS APPEARING ON THE CHEQUE
BOOK):-----------------------------------------------------------------------
vii) NAME OF THE ACCOUNT HOLDER :-----------------------------------
4.) DATE OF EFFECT :
I/We being the subscriber(s) of above telephone number(s) hereby express my/our willingness to settle the payment of regular bi-monthly telephone bills of the telephone connections referred to above through participation in E. C. S. of National Clearing Cell of Reserve Bank of India, Delhi and hereby authorise Account Officer (ECS), MTNL, Delhi to raise the debits on such regular bi-monthly telephone bills as refferred to above through this scheme electronically for adjustment against Debit in my/our above Account No------------------------
I/We have given today standing instructions to my / our bank.
|
------------------- ------------------- Signature of A/c Holder |
---------------------------------- Signature of Subscriber |
| Name in Block Letters : ---------------- | Name in Block Letters : ---------------- |
|
(In case name of Subscriber differs from that of A/C holder) |
Add---------------------------- ---------------------------- ---------------------------- |
| Above instructions received/accepted Authorised Signatory of the Bank |
Note : MTNL Copy may please be sent to A.O.(ECS) Room No. 117, K.L. Bhawan, New Delhi-110050 Tele : 3326066
Please mail the E.C.S Registration Form to the following address
:
Chief Accounts Officer (BSO),
Room No. 117, First Floor,
Khurshid Lal Bhawan, Janpath, New Delhi -110050