MANDATE FORM
Electronic Clearing Service (Credit Clearing)/Real Time Gross
Settlement (RTGS) Facility for Receiving Payment
A. DETAILS OF ACCOUNT HOLDER:
Director PGIMER Research Grant Saving Account
1 Name of account holder Chandigarh.
2 Complete contact address PGIMER Sector -12 Chandigarh-160012
3 Telephone number/fax/e-mail 0172-2755594,2755344,2755589
0172-2744401,2745078
[email protected] ,
[email protected] 4 Name & address of
project/Supplier
5 Title of the Project
B. BANK ACCOUNT DETAILS:-
1 Bank name State Bank of India
2 Branch name with complete Medical Institute Branch Sector 12,Chandigarh
address, telephone no. and 0172-2747012
E mail
[email protected] 3 Whether the branch is YES
computerized?
4 Whether the branch is YES, SBIN0001524
RTGS enabled? if yes what
is the branch’s IFSC code
(i) Is the branch also NEFT YES
enabled?
(ii) Type the bank account Saving Account
(SB/Current/ Cash Credit)
(iii) Complete bank account no. 37554596542
(latest)
(iv) MICR code of bank 160002007
I hereby declare that the particulars given above are correct and complete. If the transaction is
delayed or not effected at all for reasons of incomplete or incorrect information I would not hold the
user institution responsible.
(Signature of the DDO/AO of the concerned division) (Signature)
Certified that the particulars furnished above are correct as per our record.
Date: (Signature and seal of the bank manager)
Please attach a photocopy of cancelled Cheque for the purpose of verification of concern bank account
