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ECS FORM To Citibank Card Center P. O. Box 4830 Anna Salai P. O. Chennai - 600002 Dear Sir RE AUTHORISATION TO PAY CITIBANK CREDIT CARD PAYMENTS THROUGH THE ELECTRONIC DEBIT CLEARING MECHANSIM 1 Name 2 CITIBANK CARD NUMBER 3 Particulars of Bank Account A. These debits would be raised by Citibank every month. Please treat this as an authorization to debit my account each month. Please also inform Citibank in case this account is closed or its stat.

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