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FORM No.E-5Appendix-VIIIELECTRONIC CLEARING SERVICE (CREDIT CLEARING)(MODEL MANDATE FORM)(INVESTOR/CUSTOMER'S OPTION TO RECEIVE PAYMENTS THROUGHCREDIT CLEARING MECHANISM)(Scheme name and the periodicity of payment)No.1. INVESTOR / CUSTOMER'S NAME2. PARTICULARS OF BANK ACCOUNTA BANK NAMEBCDEFGBRANCH NAMEAddressTelephone9-DIGIT CODE NUMBER OFTHE BANK &BRANCH(Appearing on the MICR chequeIssued by the bank)ACCOUNT TYPE(S.B. Account/ Current Account orCase Credit with Code 10/11/13)LEDGER NO. /LEDGER FOLIO NO.ACCOUNT NUMBER(As appearing on the Cheque Book)IFSC Code(In lieu of the bank certificate to be obtained as under, please attach a blank cancelled cheque, or photocopy of acheque or front page of your saving bank passbook issued by your bank for verification of the above particular).3. DATE OF EFFECTI hereby declare that the particulars given above are correct and complete. If the transaction is delayed or noteffected at all for reasons of incomplete or incorrect information, I would not hold the user institiution responsible. Ihave read the option invitation letter and agree to discharge responsibility expected of me a participant under thescheme.Date:(.......................................)Signature of the Investor/Customer.Certified that the particulars furnished above are correct as per our records.Date:(.......................................)Signature of the AuthorisedOfficial from the Bank.