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FORMAT (OTS-F-12) RTGS/ Neft - Mandate Authorisation Form

The document is a mandate authorization form for suppliers to authorize RTGS and NEFT payments. It requests information from suppliers such as company name, address, bank details, account numbers and signatures to process electronic fund transfers.

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Swapnil Kamerkar
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2K views

FORMAT (OTS-F-12) RTGS/ Neft - Mandate Authorisation Form

The document is a mandate authorization form for suppliers to authorize RTGS and NEFT payments. It requests information from suppliers such as company name, address, bank details, account numbers and signatures to process electronic fund transfers.

Uploaded by

Swapnil Kamerkar
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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FORMAT (OTS-F-12)

RTGS/ NEFT – MANDATE AUTHORISATION FORM

1. Supplier’s / Vendor’s Name:

2. Supplier’s / Vendor’s Name as per Bank Records:

3A. Supplier’s Code 3B. Supplier’s PAN Number: #

# Quoting PAN No. in all the e-returns has become 100% mandatory w.e.f. 14-02-2008 hence, ensures to fill-
up this and also send a photocopy of PAN duly self-attested. If there is any difference between the name given in
the supplier’s name and name given in the PAN card, then a note to explain the reason for the difference and the
correlation between both.

4. Supplier’s / Vendor’s Complete Postal Address:


Door No. Street:
Location: District:
City: State PIN
5. Supplier’s / Vendor’s E-mail ID:

6. Supplier’s / Vendor’s Telephone Number & Mobile Phone Number:


M
7. Name of the Bank:

8. Bank (Branch) Postal Address:

9. RTGS*/NEFT** - Code of the Branch:


RTGS:
NEFT:
RTGS* - “Real Time Gross Settlement”, NEFT** - “National Electronic Fund Transfer”.
These “IFSC” Codes are unique numbers of each Branch – “ Indian Financial Services Code”. For some Branches
both the codes are the same and some Banks, may maintain one Code No. for RTGS and another Code No. for
NEFT. Hence, please fill-up both the rows, even if it is the same.

10. Nature of the Account: (Tick whichever is applicable & put ‘x’ mark for the balance two accounts)
Saving Bank Account: Cash Credit Account: Current Account:
11. Bank Account Number of the Supplier: ©
st
© Fill up from the 1 column. For the balance left out blank columns, please mention ‘x’ mark.

We hereby declare that the particulars given above are correct and complete. If the transaction is delayed for
reasons of incomplete or incorrect information, we would not hold MDL responsible.

Date: Supplier’s Seal: Authorized Signature of the Supplier:

Certified that the particulars as per Serial Numbers 2, 7 to 11 are correct as per our records.

Date: Bank’s Stamp Authorized Signature of the Officer of the Bank.

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