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MANDATE FORM FOR PAYMENT THROUGH ELECTRONIC MODE 01 NAME OF THE BENEFICIARY (FIRM’S NAME) 02 ADDRESS OF THE BENEFICIARY (FIRM’S ADDRESS) 03 CONTACT NO. 04 E-MAIL id 05 PAN NO. 06 BENEFICIARY BANK NAME 07 BANEFICIARY’S BANK ADDRESS WITH BRANCH AND PIN CODE 08 ACCOUNT NO OF BENEFICIARY 09 TYPE OF A/C SAVING/CURRENT/CASH CREDIT 10 09 DIGIT MICR CODE OF BENEFICIARY’S BANK 11 BENEFICIARY’S BANK BRANCHES IFSC CODE MANDATORY 11 CHARACTER FIELDS DATE -: SIGNATURE – NAME IN BLOCK LETTER - SEAL -: DESIGNATION -

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