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Government of Karnataka
Finance Department
Department of Treasuries
MANDATE FORM,
Electronic Clearing Service (Cre Clesting)/ Real Time Gross Settlement RTGS)/Natlonal Electronic
Fund Transfer (NEFT) faclity for receiving payments
‘ADetals of Accounts Holders:-
[restname:
ao [Un capt eter)
name of the Recipient eae
[in capital letters)
[Aadhar Number a a
lacaress 7
compete address facarasez
[Mobile Number of the a a a
[E-mail e-mail ofthe recipient)
|p. Bank Account Details of therecipient- [| | | 1 | | | | 1
[Bank Name
Sranch Name
selectthe ype of Bank cing aank curcent
laccount
[Account Number ar appearing
in the pass book)
[o digit MICR Code of Sank Branch
[FSC Code ofthe Bak I
Date of effect
"hereby declare that the particulars given above are correct and complete f the transaction fs
delayed or not effected at all reasons of incomplete or incorrect information| Would not hold the
Department responsible | have read the option Invitation letter and agree to dlscharge responsibilty
expected of me as «participant under the Scheme
Date: Signature ofthe candidate