ELECTRONIC CLEARING SERVICE (DEBIT CLEARING

 MANDATE FORM  

PROPERTY OWNERS AUTHORISATION TO PAY WATER/SEWERAGE TAX AND WATER SUPPLY/SEWERAGE SERVICE CHARGES
THROUGH ELECTRONIC MECHANISM

  AREA NO                                          DIVISION NO.                                       C.M.C.BILL NO.                             SUB NO.

 


 

 

 

 

 

 

 

 

 

 

 

  1.Property Owner's Name                                         :

 2. Particulars of Bank Account
A.        Bank Name                                                     :
B.        Branch Name                                                  :

C. 9 Digit code Number of the Bank
and Branch appearing on the MICR
Cheque issued by the Bank (please 
attach the Photocopy of the Cheque
or a blank cancelled cheque issued by
your Bank for verifying the accuracy of    
the code number                                                       :

D. Account Type
(S.B. Account /Current Account or Cash  
 credit) with Code                                                       :
 
E.Ledger Folio No.
(If appearing on the Cheque Book)                            :

 

F. Account Number
(As appearing on the Cheque Book)                          :

  G. Name of the Account Holder                                :

  3. Date of Effect                                                       :For first Half Year 15th April/
                                                                                    Second Half Year 15th Oct.of the year

  I / We being the property owner(s) hereby express my/our willingness to settle the payment regular Half-Yearly tax/charges
referred to above through participation in E.C.S. of National Clearing Cell of Reserve Bank of India, Chennai
and hereby authorise Managing Director,C.M.W.S.S.Board to raise the debits on regular Half-Year intervals through this 
scheme electronically for adjustment against credit in my/our above Account No.

  I / We have given this day standing instructions to my / our Bank (copy enclosed)


Address                                                                                                                                    (Signature of Property owner)
Date                                                                                                                                                 Name in Block Letters

                  Copy of Mandate received and accepted
           
                      (Banker Seal and Signature)                 
                                                                                                                                                  (Signature of A/c. Holder)
                                                                                                                                                        Name in Block Letters   
  Note: Cancelled Cheque to be enclosed

                                                                                         Incase Name of the Property Owner differs from this of A/c.Holder