untitled-1 [bank.indusind.com] · 2019-08-01 · ach manda te form signature primary account holder...

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AC

H M

AN

DA

TE

FO

RM

Signature Primary Account Holder

1Name as in Bank Records

Signature of Account Holder

3Name as in Bank Records

Signature of Account Holder

2Name as in Bank Records

SB CA CC SB-NRE SB NRO Others

HL

/ Ver

. 8.0

/ 07

19 /

NE

INDB 0000098

I have understood that the bank, where I have authorized the debit, may levy onetime mandate processing charges as mentioned in their latest schedule of charges published by the bank.

Place : ____________________________ __ Date : _____________ ___ Signature : __________________________________

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