BHARAT SANCHAR NIGAM LIMITED
(http://www.bsnl.co.in)

MANDATE FORM
Subscribers authorization to pay telephone bills through
Electronic Clearing Service(Debit)

   1.SUBSCRIBER’S NAME(in block letters) : ------------------------------------------------

   2.TELEPHONE NUMBER(S)*                             :

1)--------------------- 2)---------------------3)-------------------

                                                                                4)----------------------5)----------------------6)------------------------
 
 3.PARTICULARS OF BANK

  a)BANK NAME                                           --------------------------------------------------------

  BRANCH NAME &ADDRESS                   --------------------------------------------------------
  b) 9 DIGIT CODE NUMBER OF THE BANK BRANCH:     

  (Appearing on the MCIR cheque issued by the bank. Please consult your banker)  
  

 c) ACCOUNT TYPE(S.B Account/Current Account/Cash Account):-----------------------------

  d) ACCOUNT NUMBER:  --------------------------------------------------

  e)LEDGER FOLIO:     --------------------------------------------------  
  (if appearing on the cheque)
  

  f) NAME OF THE ACCOUNT HOLDER:    --------------------------------------------------

                      I/We here by declare that the particulars given above are correct and express my/willingness to settle the payment of  regular bi-monthly telephone bills referred to above through participation in E.C.S of Reserve Bank of India,____ (Place)  and here by authorize Accounts Officer (TR) , ___________(Place)  Telephones to raise debits on such regular bi-monthly telephone bills as referred to above through this scheme electronically for adjustment against my/our account In the event of my bank being unable to debit my /our account for what so ever reasons, I/We will pay the bills directly to ____________(Place) Telephones by cash. I/We will inform _________(Place) Telephones any changes in my /our Bank Account.

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

                  “Kindly accept  any debit raised by RBI   against my account no ----------------------

for telephone number/s -----------------, -----------------------, ---------------------,-------------------,

--------------------- ,-----------------,------------issued   to     ---------------------------------(AccountHolder's Name)

by Bharat Sanchar Nigam Limited”.

                                                            ------------------------------











                                                (Signature of the AccountHolder)