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    ECS Mandate Form

    Uploaded by

    Manoj Patiyal

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    ECS Mandate Form

    Uploaded by

    Manoj Patiyal
    64 views2 pages

    Original Title

    ECS Mandate Form (1)

    Copyright

    © © All Rights Reserved

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    PDF, TXT or read online from Scribd

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    Copyright:

    © All Rights Reserved
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    Download as pdf or txt
    64 views2 pages

    ECS Mandate Form

    Uploaded by

    Manoj Patiyal

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    ECS Mandate Form

    Postal Life insurance of India

    1 Name of the Policy Holder----------------------------------------------------------------------------------------


    2 Policy Details :
    S.NO. New proposal/Policy number Name of Insured

    3 Contact information
    a Residence -------------------------------
    b Office -------------------------------
    c Mobile -------------------------------
    d Email ID -------------------------------

    4 Particulars of Bank AC(Account from which you want to pay the premium)
    a Bank Name --------------------------------
    b Branch Name & Address --------------------------------
    c Name of account holder --------------------------------

    Account Type(Saving/Current/Cash or
    d Credit) --------------------------------
    e Account Number --------------------------------
    9 Digit MICR CODE Number of the bank
    f and branch --------------------------------
    (Attach a photocopy/Cancelled cheque
    leaf) --------------------------------

    5 I/We agree that this Mandate will form an integral part of my/our proposal (Only for new proposals)
    (2) If in future my/our Bank Account is transferred to a city where ECS facility is not available, a change of
    mode will be necessary which will involve change in premium.
    (3) I / We hereby instruct the bank to debit my/our above Account No. and pay PLIPremium of
    Rs.________________ as above/as per demand sent by PLI.
    I/we, hereby, declare that the particulars given above are correct and complete. I/we being the holder/s of the
    above policy/policies express my/our willingness to remit the premium/s referred to above through
    participation in ECS of National Clearing Cell of Reserve Bank of India and hereby authorise the Life
    Insurance Corporation of India to raise the debits on my/our Bank Account towards the said premium/s due
    referred above. If any transaction is delayed or not effected at all for the reasons of incomplete or incorrect
    information or non-availability of funds or closure of Accounts etc. I would not hold PLIor the user
    institution responsible. I understand that the first transaction after authorization may take one month time in
    getting the process commenced. I also understand that I can pay the premium only on behalf of my near
    relatives as prescribed by the Income-Tax Act, 1961.

    PLACE Date Signature of Policy Holder

    Signature of Account Holder

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