INSTRUCTIONS TO FILL MANDATE

UMRN is auto generated during mandate creation and is mandatory to be updated during amendment and cancelation of mandate.(Maximum length-20 Alpha Numeric Characters).
Date in DD/MM/YYYY format
Sponsor Bank IFSC/MICR code, provided by the blank by the bank to the client
Utility Code of the services provider.(Maximum length-18 Alpha Numeric Characters)
Name of Service Provider
Tick on box to select type of Action to be initiated.
Tick on box to select type of Action to be affected.
Customer's legal Account Number,(Maximum length-35 Alpha Numeric Characters )
Name of Bank and Branch.
IFSC/MICR code of customer bank.Maximum length-11 Alpha Numeric Characters )
Amount payable for services or maximum Amount per traction that could be processed, in words.
Amount in figures, similar to the amount mentioned in words. (Maximum length-13digit Numeric, in paise)
Service provider generated consumer reference number.
Service provider generated scheme/plan reference number.
Tick on box to select Frequency of transaction.
Validity of mandate with date in DD/MM/YYYY format.
Name of customer/s and signatures as well as seal of company (where required.) (Maximum length-40 Alpha Numeric Characters )
Telephone no. Or Mobile no. Of Customer.
Email address of customer.
Submit form and send the printout to following address:
Deepak Kumar Sales(R&R)
DISHTV India Ltd.
FC - 19, Sector 16 A, Film City,
Noida, Uttar Pradesh,
India.
Pincode - 201 301

	MANADATE INSTRUCTIONS FORM/NACH/ECS/DIRECT DEBIT/STANDING INSTRUCTION
	UMRN Date
Tick CREATE MODIFY CANCEL	Sponsor Bank Code Uitility Code
	I/We Hereby Authorize to debit(tick) SB CA CC SB-NRE SB-NRO Other
	Bank a/c Number
With Bank IFSC or MICR
An Amount Of Rupees Rs
Frequency Mthly Qthly H-Yrly Yrly As & We presently Debit Type Fixed Amount Maximum Amount
Ref 1 Phone No.
Ref 2 Email ID
PERIOD
From
To
Or Until Cancelled 1. 2. 3.