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INDUSIND BANK ACH MANDATE INSTRUCTION FORM O F F I C E U S E O N L Y P E R S O N A L L O A N A / C N U M B E R A P P L I C A T I O N I D Signature as per Bank Record Name as in bank records Signature as per Bank Record Signature as per Bank Record Name as in bank records Name as in bank records I agree for the debit of mandate processing charges by the bank whom I am authorizing to debit my account as per latest schedule of charges of the bank. CIT I 0 0002000000037 CI T I 0 0 0P IG W - This is to conrm that the declaration has been carefully read, understood & made by me/us. I am authorizing the user entity/ Corporate to debit my account, based on the instructions as agreed and signed by me. - I have understood that I am authorised 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. PLEASE FILL IN BLOCK LETTERS ONLY INDUSIND BANK ACH MANDATE INSTRUCTION FORM O F F I C E U S E O N L Y P E R S O N A L L O A N A / C N U M B E R A P P L I C A T I O N I D Signature as per Bank Record Name as in bank records Signature as per Bank Record Signature as per Bank Record Name as in bank records Name as in bank records I agree for the debit of mandate processing charges by the bank whom I am authorizing to debit my account as per latest schedule of charges of the bank. CIT I 0 0002000000037 - This is to confirm that the declaration has been carefully read, understood & made by me/us. I am authorizing the user entity/ Corporate to debit my account, based on the instructions as agreed and signed by me. - I have understood that I am authorised 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. PLEASE FILL IN BLOCK LETTERS ONLY I have understood that the bank, where I have authorized the debit, may levy onetime mandate processing charges as mentioned in their latest schedule of charges published by the bank. 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. Place : ______________________________ Date : ________________ Signature : __________________________________ CI T I 0 0 0P IG W Signature as per Bank Record
