MAHANAGAR TELEPHONE NIGAM LIMITED, MUMBAI
ELECTRONIC CLEARING SERVICE (DEBIT CLEARING)

MANDATE FORM Utility Code : 4009060

SUBSCRIBER'S AUTHORISATION TO PAY TELEPHONE BILLS THROUGH ELECTRONIC DEBIT
CLEARING MECHANISM

1. SUBSCRIBER' NAME AND ADDRESS _____________________________________________
_____________________________________________________________________________
2. TELEPHONE NUMBER
_____________________________________________________________________________
(if more telephone nos. attached separate list)
C.A.NO.
_____________________________________________________________________________
3. PARTICULARS OF BANK ACCOUNT:______________________________________________
(i) BANK NAME____________________________________________________________
(ii) BRANCH NAME_________________________________________________________
(iii) 9-DIGIT CODE NUMBER OF THE BANK AND BRANCH APPEARING ON THE MICR
CHEQUE ISSUED BY THE BANK
(PLEASE ATTACH CANCELLED CHEQUE LEAF)
(iv) ACCOUNT TYPE (S.B.ACCOUNT/CURRENT ACCOUNT OR CASH CREDIT)
WITH CODE 10/11/13
(v) LEDGER FOLIO NO. (IF APPEARING ON THE CHEQUE BOOK)__________________
(vi) ACCOUNT NUMBER (AS APPEARING ON THE CHEQUE B00K)__________________
(vii) NAME OF THE ACCOUNT HOLDER_________________________________________
4. UPPER LIMIT RS._________ START DATE ____________________
END DATE ____________________
5. Narration . 1(Biller) __________________________________________________________
6. Customer Relationship No. ____________________________________________________
7. Mandate Handover Date :- __________________________________________________
My/Our Account may not be debited, if the bill amount exceeds the above upper limit.
I/We being the subscriber(s) of above telephone number(s) hereby express rny/our willingness to
settle the payment of regular monthly I bi-monthly telephone bills of the telephone connections referred
to above through participation in ECS of National Clearing cell o f Reserve Bank of India. Mumbai and
hereby authorise MTNL, Mumbai to raise the debits on such regular monthly I bi-monthly telephone
bills as referred to above through this scheme electronically for adjustment against Debit in my/our
above account No.__________________________
I/We have given today standing instruction to My/our Bank (Copy enclosed)
*Signature of Alc Holder Signature of Subscriber
Bank Attestation ________________________________________________
__________________________________________________________________________________
Mandate Form duly filled may be submitted to any QCSC.
Saving Bank A/C - 10 / Current Bank A/C - 11 / Cash / Credit A/C - 13