Scb Credit Card Form – Fill Out and Use This PDF

ELECTRONIC CLEARING SERVICE (Debit Clearing) MANDATE FORM

Authorization of Customer to remit funds / payments to Standard Chartered Bank (SCB) through Electronic Clearing Service

I/We hereby, authorize SCB and their authorised service providers, to debit my/our following bank account by ECS (Debit Clearing)

SCB Utility Code - 6009068 (All Regions except Surat, Bhopal, Baroda, Indore & Lucknow)

SCB Utility Code

Surat 3951054

Bhopal 4629011

Baroda 3909101

Indore 4529010

Lucknow 2269013

(Form to be filled up in capital letters only)

CUSTOMER’S NAME

Applicant Name

Co-Applicant Name

PARTICULARS OF BANK ACCOUNT

PARTICULARS OF DEBIT INSTRUCTION

DEBIT REFERENCE NO.

(loan, cell, phone, policy no. etc)

BANK / UTILITY NAME

UPPER LIMIT FOR ECS DEBIT (IN INR)

EXPIRY DATE

D D M M Y Y Y Y

DECLARATION AND SIGNATURE/S

I/we hereby declare that the particulars given above are correct and complete. If the transaction is delayed or not affected at all for reasons of incomplete or

incorrect information, I/we would not hold the user institution responsible. I/We have read all the terms and conditions as are applicable for availing of this ECS Debit service and agree to discharge the responsibility expected of me/us as a participant under the scheme. I/We also hereby authorize our representative carrying this ECS Debit Mandate Form to get it verified and executed by my/our Bank.

All Signatures as in the Bank Records. All Joint Account holders are required to sign.

For user by Customer / Account Holder's Bank

We hereby certify that the particulars of the customers furnished above are correct as per our records, and we hereby declare that a copy of this mandate form, duly complete and signed, has been submitted to us.

Bank Stamp	Signature of Authorised Official of the Bank
Name	Branch

Designation

Date

ID NO.

ACCOUNT TITLE

CONTACT TEL NO.

ADDRESS

ACCOUNT NO.:

(Please turnover to sign)

Electronic Debit Authorisation to Bank Account

(To be filled in by Borrower if repayment is through ECS)

To,

The Manager Operations,

Centralised Loan Processing Unit (CLPU)

Standard Chartered Bank,

58, Armenian Street,

Chennai - 600 001

Dear Sir,

RE: Authorisation to pay loan amount vide equated monthly installments (“EMI”) to CLPU, Standard Chartered Bank (“Bank”) through the Electronic Debit Clearing Mechanism.

Please arrange to incorporate a standing instruction to debit my / our bank account towards payment of my / our loan amount vide EMI and / or any overdue / late charges / cheque bounce charges as per the details given below:

Loan account number:

Loan account number:

Name:

Particulars of Bank account

A. Name of Account Holder:

B. Bank Name:

C. Branch Address:

D. Account Number:

I / We, having a Bank loan account, as mentioned above, hereby express my / our unconditional consent to debit payments of my / our loan amount vide EMI and / or any overdue/ late charges / cheque bounce charges referred to above through participation in the Electronic Clearing System (“ECS”) of the National Clearing Cell of the Reserve Bank of India and hereby unconditionally and irrevocably authorize the Bank to raise the debits on such regular payments as referred to above, against my / our bank.

I / We hereby declare that the particulars given above are correct and complete and if the transaction is delayed or not effected at all for reasons of incomplete or incorrect information I / We would not hold the Bank responsible. I / We agree and understand that my / our bank shall be informed of these debits as per the enclosed letter. I / We shall advise them of the same and I / We understand that the instruction cannot be withdrawn / cancelled except with the written consent of the Bank, for the payment of the loan amount vide EMI and / or any overdue / late charges / cheque bounce charges.

Signature of Sole / First Account Holder	Name

Signature of Second / Joint Account Holder

Name

(Please Note: To be signed by all account holders as per mandate on the savings / current a/c with your bank)