MANDATE FORM

1. YOUR P.A.N. NUMBER/
     GIR NUMBER
2. YOUR NAME & ADDRESS
3. THE NAME OF YOUR BANK
    AND BRANCH ADDRESS
4. THE NINE DIGIT CODE 
    NUMBER OF YOUR BANK
   AND BRANCH
5. YOUR ACCOUNT TYPE
    (SAVINGS / CURRENT / CASH CREDIT)
6. YOUR ACCOUNT LEDGER 
     FOLIO (IF ANY)
7. YOUR ACCOUNT NUMBER
    (AS APPEARING IN YOUR
    CHEQUE BOOK)     
8. AND THE FOLLOWING
    DECLARATION
    "I hereby declare that the particulars given are correct and complete.  If the transaction is delayed
     or not effected, for reasons of incomplete or incorrect information, i would not hold the user
      institution responsible.  I agree to discharge the responsibility expected of me as a participant
      under the ECS."

Signature of Assessee  

ATTACH A CANCELLED BLANK CHEQUE OF YOUR BANK A/C.