In today's fast-paced financial environment, understanding the mechanisms of electronic transactions is crucial for both individuals and businesses. Among the various documents facilitating these transactions, the No E 5 form plays a pivotal role, especially in the context of Electronic Clearing Service (ECS) for debit clearing. Intended for official use by banks, this mandate form is a critical document that enables the automated debit of an account holder's bank account, allowing for smooth and efficient payment transfers to entities like ICICI Bank Limited. Required to be filled in capital letters, the form collects comprehensive information from the account holder, including bank and branch details, account type, number, and specifics about the ECS transaction like the date of effect, periodicity, and installment amounts. Additionally, it mandates a declaration from the account holder confirming the accuracy of the provided information and their understanding of the responsibilities it entails. Signatures from all account holders (in the case of joint accounts) and a bank official, alongside the bank's stamp, validate the form. Furthermore, it specifies that copies of this mandate should be distributed among the bank, the user company, and the customer, ensuring transparency and accountability across all parties involved. This form highlights the interconnectedness of individual account holders, banks, and beneficiary companies, underpinning the trust and reliance fundamental to electronic transactions in the modern economy.
| Question | Answer |
|---|---|
| Form Name | Form No E 5 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | mandate form, mandate from bank, bank mandate form format, bank mandate example |
FORM |
Appendix – VIII |
LAN No. (Only for official use)
ELECTRONIC CLEARING SERVICE (DEBIT CLEARING) MANDATE FORM
Please
The Manager
(Bank Name)___________________________________________________________
(Branch Name)_________________________________________________________
(Address) _____________________________________________________________
Telephone No._________________________________________________________
Copy to the User Company
Name
Address
Telephone
I (* Account Holder Name) ________________________________________________________________________ (as per
Bank records) hereby authorize you to debit my account for making payment to `ICICI Bank Limited ‘ through ECS
(Debit) clearing as per the details given as under.
A. *
B. * ACCOUNT TYPE |
: |
Savings : (10 / 31) / Current : (11 / 29) / Cash Credit : (13) / NRE / NRO |
C. LEDGER NO / LEDGER
FOLIO NO.:
D. * ACCOUNT NUMBER (As per Bank Records)
Name of the Scheme
Date of effect Periodicity
(M/BiM/Qly/etc.)
Amount of installment/ Amt of bill with upper limit
Number of installments/ Valid up to (in case of utility bills)
E. |
Date of effect |
: |
I 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.
(…………………………………) (…………………………………) (…………………………….) (….…………………………)
Signature of the Customer (Account Holder/s) - In case of Joint A/c holders, Signature is required of all A/c holders.
Any one Signature required, In case of Either / Survior A/c.
Date :
Certified that the particulars furnished above are correct as per our records.
(Bank’s Stamp) |
|
Date : |
Signature of the Authorized official from the Bank |
(Note:- Mandate to be obtained in 3 copies, Original for Bank, One for User Co. and other for customer)
For ICICI BANK LTD Use only (To be filled by Business Team)
Name of the Applicant __________________________________________________________________________________
Name of the
Bank Name___________________________________ Branch____________________ City __________________________
Application Number_____________________________________________________________________________________
Fresh_____________Swap__________________ In case of Swap previous mode________________________________
* Mandatory Fields