TRADING & DEMAT ACCOUNT OPENING FORM - NJ PMS

Regd. Office: Floor 25,BANK MANDATEElectronic Clearing Service (Debit Clearing)BSE LimitedP.J Towers, Dalal Street, Fort, Mumbai – 400001, Maharashtra*Customer Reference No:(UCC)The Manager*Bank Name:*Mandate Reference No:U I Code:*Branch Name:*Address:Telephone No:I/we hereby authorize you to debit my/our account (ECS Debit clearing) for making payment to BSE Limited (through their service provider) as per thedetails given as under.*Name of Account Holder:*MICR - 9 Digit Code No.s of the Bank & Branch (Appearing on the MICR cheque issued by the bank):* Mode of Holding: SingleJointEither or Survivor*Account Type: S.B. Account Current Account Cash Credit*Bank Account Number:*Account holder names (As per bank’s record):1st A/c Holder:2nd A/c Holder:3rd A/c Holder:Name of the Scheme * Start Date Periodicity *Amount (Upper Limit) *End DateI/We hereby declare that the particulars given above are correct and complete in all respects. If the transaction is delayed or not effectedat all for reasons of incomplete or incorrect information, I/we would not hold the user institution responsible. I have read the optioninvitation letter and agree to discharge the responsibility expected of me/us as a participant under the scheme.This is to inform that I/We have registered for the RBI’s Electronic Clearing Service (Debit Clearing), and that my/our payment towardsmy/our obligation in BSE Ltd. (thru its service provider) shall be made from my/our above mentioned bank account with your bank. I/Weauthorize the representative carrying this ECS (Debit Clearing /Standing Instruction) mandate form to get it verified & executed.I/We hereby authorize the bank to debit my/our account for Mandate verification charges if any.Signature(s) of the account holder(s). (As per bank’s record)Daily*Date: D D M M Y Y Y Y*Indicates mandatory field.1. 2. 3.For Bank Use OnlyCertified that the particulars furnished above are correct and as per our records.Bank’s StampDate: D D M M Y Y Y YSignature of the Authorized official from the Bank