FOR OFFICE USE    

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

 1. Subscriber's  Namein block letters) : ------------------------------------------------   
2. Telephone Number(s)*                   :1)---------------------2)---------------------3)-------------------                        
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):   ------------------------------     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, Hyderabad and here by authorize Accounts Officer (TR) , Hyderabad 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 Hyderabad Telephones by cash. I/We will inform Hyderabad Telephones any changes in my /our Bank Account.                     I/We have given today standing instructions to my/our Bank(copy enclosed)



The details Enclosed above are correct as per our records. Bank Stamp     Authorised Signatory

(Signature of Subscriber)

(In case name of Subscriber
differs from that of A/c holder)

Name of Account Holder
(In block letters)


Kindly accept any debit raised by RBI   against my account no ----------------------for telephone number/s -----------------, -----------------------, ---------------------,-------------------,

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

by Department of Telecom Services”. ------------------------------ (Signature of the AccountHolder)