51今日大瓜

Bank Debit Form

Le Cadre Parfait
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When I registered with the Impots website I was given a Mandate to send to my bank so that they could debit my account. In return my bank sent me this form to fill out. I was able to fill out a majority of it but I got to this part and I am unclear what they are asking for here. Is this something the bank fills out? I have not seen these numbers before. Any help would be appreciated!

R茅f茅rence cr茅ancier (ICS) (脿 renseigner obligatoirement): [ ]
R茅f茅rence mandat (RUM) (脿 renseigner obligatoirement): [ ]
Emis par (nom du cr茅ancier) (脿 renseigner obligatoirement): [ ]
Type de pr茅l猫vement (脿 renseigner obligatoirement) : 鈻� ponctuel. 鈻� r茅current
Date d茅but de validit茅 (脿 renseigner obligatoirement): __/__/20__au plus t么t, 3 jours ouvr茅s 脿 compter de la date de
r茅ception par la Caisse r茅gionale de la pr茅sente demande d鈥檃utorisation)

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