(Investor(s)’s option to receive redemption proceeds and
interest payments through Credit Clearing Mechanism)

1) Investor(s)’s name & address               :

2) (a) Member ID No./BLA No.                  :

(b) PAN/GIR No.*                                  :

(c) Telephone No./Mobile No./E-mail ID:

3) Particulars of Bank account

A          Name of the Bank       :

B          Name of the branch     :

            Address                      :

            Telephone No.             :

C          9-Digit code number of the bank and branch
            appearing on the MICR cheque issued by the bank:

D          Type of the account (Savings, Current or Cash Credit)
             with code (10/11/13)     :

E          Ledger and Ledger folio number:

F          Account number (as appearing on the cheque book):
 
(In lieu of the bank certificate to be obtained as under, please attach a blank cancelled cheque or photocopy of a cheque or front page of your savings bank passbook issued by your bank for verification of the above particulars)

4) Date of effect :

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/We would not hold the user institution responsible. I/We have read the option invitation letter and agree to discharge the responsibility expected of us as a participant under the scheme.

Date:

(.....................................)
Signature(s) of the Investor(s)

(In case of joint holdings, all the investors, whose signatures are registered with PDOs, should sign here)
---------------------------------------------------------------------------------------------------------  

Certified that the particulars furnished above are correct as per our records.

Bank’s Stamp:

Date:

(.................................)
Signature of the authorised
official of the Bank

*: Compulsory for investors due to receive maturity proceeds exceeding Rs. One lakh