TRADING & DEMAT ACCOUNT OPENING FORM - NJ PMS

BANK MANDATEElectronic Clearing Service (Debit Clearing)/ Direct DebitNJ India Invest Pvt. Ltd.Regd. Office : 9th FLoor, B Tower, Udhna Udyognagar Sangh Commercial Complex, Central Road No.10, Udhna, Surat - 394210, Gujarat.*Customer Reference No:The Manager*Bank Name:*Mandate Reference No:UI Code:*Branch Name:*Address:Telephone No:I hereby authorize you to debit my account for making payment to NJ IndiaInvest Pvt. Ltd. through ECS (Debit) clearing / Direct Debit as per the details givenas under.*Name of First/Sole Applicant:Mode of Payment (Please tick): ECS Direct Debit*MICR - 9 Digit Code Numbers of the Bank & Branch (Appearing on the MICR cheque issued by the bank):*Mode of Holding: Single Joint Either or Survivor*Account Type: S.B. Account Current Account Cash CreditLedger No / Ledger Folio No:*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*Date ofEffectPeriodicity(M/BiM/Qly/etc.)*Amount(Upper Limit)*Number of installments/Valid upto (in case of utility bills)/End DateDaily*Debit Start Date:I/We hereby declare that the particulars given above are correct and complete. If the transaction is delayed or not effected at all for reasons ofincomplete or incorrect information, I would not hold the user institution responsible. I have read the option invitation letter and agree to dischargethe responsibility expected of me as a participant under the scheme.This is to inform that I/We have registered for the RBI’s Electronic Clearing Service (Debit Clearing)/Direct Debit/Standing Instruction and that mypayment towards my loan/investment in NJ IndiaInvest Pvt. Ltd. shall be made from my /our above mentioned bank account with your bank. I/Weauthorize the representative carrying this ECS (Debit Clearing/Direct Debit/Standing Instruction mandate form to get it verified & executed.Signature(s) of the account holder(s). (As per bank’s record)*Date:1.2.3.*Indicates mandatary field.For Bank Use OnlyCertified that the particulars furnished above are correct and as per our records.Bank’s StampDate:Signature of the Authorized official from the Bank