CONSUMER FINANCE DIVISION (CFD)

PPD

CVD

AUTHORISATION OF THE BENEFICIARY TO RECEIVE PAYMENTS / CREDIT THROUGH E-ROUTE (BY WAY OF A/C TO A/C TRANSFER AND/OR RTGS/NEFT)
1. Category 2. Name of the beneficiary 3. Address of the beneficiary 4. Legal status of the beneficiary Individual Pvt Ltd Company : Trusts Hindu Undivided Family Partnership Others (State) PAN NO . (Please Specify) (Registered Business Address) : DEALER : : City State Email ID. Sole Proprietorship Public Ltd Company District Pin code VENDOR / SERVICE PROVIDER

5. Sales Tax Regn. No. (CST) Service Tax Regn. No.

Indusind Bank Details (1) Indusind Bank Limited : : : : : : : : : : : : : :

6. Particulars of Bank Accounts : (a) Bank Name (b) Branch Name Address City District State Pincode Phone No. (with STD CODE) (c) 9 digit MICR CODE
(as appearing in Physical Cheque)

Other Bank Details (2)

2 3 4
SB CC

SB CC CA NRO NRE FCNR

(d) IFSC Code (e) Account Type (f) Ledger No/ folio No. (g) Account no. (h) Account held In the name(s) of (i) Operating mode

I N D B
CA NRO NRE FCNR

(i) (ii) (iii)

(i) (ii) (iii) E or S A or S

E or S

A or S

I / We have enclosed herewith: (a) Duly cancelled specimen cheque(s) drawn on our above account(s); (b) Copy of bank pass book first page and last page (showing last six months transactions) where the bank is computerized, the account statement showing last six months transactions; (c) Dealership certificate (if applicable); (d) Sales Tax Certificate Copies (CST & LOCAL); (e) PAN Card copy; (f) Service Tax Registration Certificate Copy; (g) Recent passport size photograph (in case of individuals / proprietorship / HUF); (h) Identity Proof (in case of individuals / proprietorship / HUF); ( i) Business Proof etc. Please peruse the documents and arrange to start crediting all payments due to me/us vide e-route through A/C to A/C Transfer / RTGS / NEFT Settlement. I/We hereby declare that the particulars given above are true and correct and express my/our willingness to receive all payments due to me /us as per this request. I/We note and confirm that if the transaction of remittance is delayed or not effected for any reasons of incomplete / incorrect information or request given from my/our side (or) due to reasons beyond the control of you (IBL), I/We would not hold you (IBL) or your Employees or Agents or those who have acted on your behalf responsible. I/We also agree to keep you formally informed about any changes in my/our bank account details.

For __________________________________ (Beneficiary) Name of Authorized Signatory Designation of Authorized Signatory 7. For Office Use : Dealer / Beneficiary Code Created on Status updated on For Existing beneficiary (s) : : : : : D D M M Y Y Y Y CFD State Code Created By Verified By : : : CFD Location Code : Date Place : :

Note : Mandate (to be prepared in 1+1 and Submitted along with self-attested document copies) to be signed by the Beneficiary