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HB PORTFOLIO LTD
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ECS MANDATE
FORM
I/We hereby authorise you (HB Portfolio Ltd) to credit
all future dividends, if any, in respect of my holding in your company to my
bank account as detailed below by Electronic Clearing Service introduced by
Reserve Bank of India:
1. Share Holder's Name (in Block letters) : ____________________________________
2. Folio No./DP ID & Client ID No. :
____________________________________
3. No. of Shares held : ____________________________________
4. Name of the Bank :
____________________________________
5. Branch Name & Address : ____________________________________
____________________________________
6. Account Type : SB A/c Current A/c Others ___________
(Mark
" Ö " in the appropriate box) (Please specify)
7. Ledger Folio No. of the Account :
_____________________________________
8. Bank Account Number : _____________________________________
(as appearing on Cheque Book)
9. Nine digit code number of the Bank and :
Branch appearing on the MICR Cheque *
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* Please attach
photocopy of a cheque or a blank cancelled cheque issued by your Bank
relating to your above account for verifying the accuracy of the code number.
I/We hereby declare that the particulars given above are
correct and complete. If credit is not
effected for reason(s) of incomplete or incorrect
information, I/We will not hold the Company
responsible.
Signature
of the First holder
Dated: (as appearing in the Company's/DP's
records)