BANK COPY

MAHANAGAR TELEPHONE NIGAM LIMITED
(A Govt. of India Undertaking)
Office of Executive Director, K.L. Bhawan, New Delhi-110050
             ELECTRONIC CLEARING SERVICE (DEBIT CLEARING)
MANDATE FORM
SUBSCRIBER'S-AUTHORISATION TO PAY TELEPHONE BILLS THROUGH 
ELECTRONIC DEBIT CLEARING MECHANISM

(FOR OFFICIAL USE)                                                                                                   FORM NO.

1 SUBSCRIBER'S NAME    :__________________________________________________________________ 

2. TELEPHONE NUMBER  :    

                                       (if more telephone nos. attach separate list signed by competent authority)

3. C.A. NO.      :  

                                       (Please attach the Photocopy of the last paid bill.)

4. 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 the photocopy of a cheque or a cancelled cheque leaf)
iv) ACCOUNT TYPE (S.B. ACCOUNT /CURRENT
 ACCOUNT/ CASH CREDIT) WITH CODE 10/11/13 :   SB         Current        Cash Credit

v) LEDGER FOLIO NO.(if appearing on the cheque book) :________________________________________ 
vi) ACCOUNT NUMBER (as appearing on the cheque book) :_______________________________________ 
vii) NAME OF THE ACCOUNT HOLDER :________________________________________________________ 
5. UPPER LIMIT (if any) :___________________________________________________________________ 

I/We being the subscriber(s) of above telephone number(s) hereby express my/our willingness to settle the payment of regular month/bi-monthly telephone bills of the telephone connections referred to above through participation in E.C.S. of National Clearing cell of Reserve Bank of India,delhi and hereby authorise Accounts Officer (ECS), M.T.N.L.Delhi to raise the debits on such regular monthly/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 instructions to my/our Bank.

_____________________                                                 ______________________
 Signature of A/C Holder                                        Signature of Subscriber

Name in Block Letters _____________________         Name in Block Letters____________________________
(in case name of Subscriber differs that of A/c holder)    Add ________________________________________
                                                                                  ________________________________________

Authorised Signatory of the Bank
       Bank's stamp
Certified that the particulars furnished regarding bank
are correct as per  our record.                                                                                                   

Note : After verification from the bank MTNL Copy may please be sent to A.O. (ECS) Room No. 325, 
K.L. Bhawan New delhi-110050 Tele .No.:23326066  Toll. Free No.: 1600113399  Fax No. 23353921

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