BANK MANDATE

Electronic Clearing Service (Debit Clearing)

BSE Limited
Regd. Office : Floor 25, P.J Towers , Dalal Street , Fort , Mumbai – 400001 , Maharashtra

*Customer Reference No: *Mandate Reference No:

(UCC) UI
Code:
The Manager
*Bank Name:
*Branch Name:
*Address:
Telephone No:
I hereby authorize you to debit my account (ECS Debit clearing) for making payment to BSE Limited (through their service provider) as per the details 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: Single Joint Either 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:
*Amount
Name of the Scheme * Start Date Periodicity (Upper Limit) *End Date

Daily

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 of incomplete or incorrect information, I would not hold the user institution responsible. I have read the option invitation letter and
agree to discharge the 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)/ and that my payment towards my obligation in
BSE. Ltd. (thru its service provider) shall be made from my /our above mentioned bank account with your bank. I/We authorize the representative
carrying this ECS (Debit Clearing /Standing Instruction) mandate form to get it verified & executed.

I 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)

*Date: 1. 2. 3.

*Indicates mandatory field.

 For Bank Use Only
Certified that the particulars furnished above are correct and as per our records.

Bank’s Stamp
Date: Signature of the Authorized official from the Bank