CUSTOMER APPLICATION FORM

(NRI Savings Account)

Primary Applicant Name: Ms Muskaan Jitesh Jiwani

Joint/Co-Applicant 1 Name:

Customer ID: Lead No.: 789594717 Status Code: Date: 16-08-2023

Account No.: Track ID: 3619666 Promotional Code: PB001
Product: NRI PRO ACCOUNT Demat Account No.:
The name on the account will be updated as per passport only. Any alterations in the form need full signature of applicant.
I have above Account with ICICI Bank which I want to convert to NRO Savings Account

NOMINATION FOR ACCOUNT (Please tick as applicable)

I/We have been explained about the benefits of the nomination facilities in the account. I/We have agreed to appoint a nominee ✔ not agreed to appoint a

nominee in the account, as per the details set out in the Electronic Account Opening Form.

DECLARATIONS

I/We the undersigned declare, confirm and agree as sub-contract any part of the banking operations to a third
follows: party on such terms as deemed fit by the Bank.
1. The details in the Electronic Application Form bearing 7. I/We hereby agree that to the extent of acting in good
the above Reference Number have been entered by faith, the Bank shall be entitled to act/ rely or refuse to
me/us or at my/our directions and all the particulars act/ rely, at its sole discretion, upon any Instructions or
entered in Electronic Application Form (EAF) and this Documents, whether confirmed by me/us in writing or
Customer Application Form (CAF) including the attached not, for any purpose and shall not be liable for such
photograph are true and correct and I/we have not decision to me/us/third party.
withheld any information required for opening an 8. I/We understand that the Application Form provided by
account. me/us is governed by the laws of the Republic of India
2. That I/we are aware that my/our account shall also be and I/we, therefore, undertake to be bound by the
governed by the terms and conditions and other terms applicable laws and regulations, including the extant
and conditions as available in the website regulations provided by the Reserve Bank of India (RBI).
www.icicibank.com (‘Website’). I/We have read, 9. I/We authorize the Bank act and rely on any instructions,
understood and agree to abide and comply with the communication/ signature for any purpose (including but
same including changes made from time to time, which not limited to the instructions/communications
changes will be updated on the Website. pertaining to the operation of all our Accounts or to any
3. I/We agree and confirm that in case of inconsistency other related services) which may from time to time be or
between the account opening documents and Know purport to be given by any form of electronic
Your Customer (KYC) document provided by me/us, the communication by me/us (“Instructions”).
Bank at its sole discretion, shall have the right to update 10. I/We authorize the Bank to act and rely on any
the information in accordance with the KYC documents information/document provided by me/us, including the
without any prior notice to me/us. photograph (s), signature(s), identity proof (s), overseas
4. I/We understood and agreed that CAF/EAF can be address proof (s) and any annexures /declarations sent
rejected the Bank for any reason whatsoever, without by me/ us (the “Documents”) for any purpose (including
any liability, at its sole discretion and shall decline any but not confined to compliance with applicable KYC/
instructions issued by me/us, if any. The Bank may AML norms and for any verifications and/or authorization
require me/us to apply for a physical account opening in purposes) through means of electronic communication
case of any discrepancy. from time.
5. I/We hereby declare that I am/we are non-resident 11. I/We further declare and undertake that any transaction
Indian(s) (“NRI/s”) or Person(s) of Indian Origin (“PIO/s”) involving foreign exchange shall be in compliance with
as defined under the Foreign Exchange Management the provision of FEMA and/or any other laws applicable
Act, 1999 & 2016 and the applicable regulations, rules, to NRI/PIOs for account(s).
notification, direction or order made thereunder 12. I/We hereby undertake to intimate the Bank on my/our
(collectively, “FEMA”). I/We understand that the Bank return to India for permanent residence immediately on
shall solely rely on the arrival. Further, I/we undertake to close any of the above
statements/declarations/undertaking and confirmations accounts (maintained/ or operated by me/us in my/ our
provided by me/us for the purpose of account opening capacity of an NRI/PIO (as applicable) on my/our
and that in case any of the statements /declarations / becoming a Resident Indian or convert the above
undertaking and confirmations made herein are found to account (also a resident account wherever such
be incorrect/ false/misleading, the Bank shall not be conversion is possible at Bank’s end).
bound to accept and/or process the application. 13. If our account is opened basis submission of Permanent
6. I/We understand and agree that my/our submission of Account Number (PAN) acknowledgement number, I/we
this Application Form and its receipt by the Bank acts as undertake to submit PAN within <90> days of this CAF,
an instruction to the Bank but does not mean that the failing which the Bank reserves the right to close or
Bank has approved this Application Form or is bound to freeze the operation of my/our account.
abide by my/our instruction(s). I/We undertake to 14. If our account is opened basis Form 60, I/we declare that
provide any further information/ document as maybe I do not have PAN and my/our estimated total (including
required for the purpose of the application and the income of spouse, minor, child, etc. as per Section 64
verification. In this regard, I/We understand that pursuant of Income Tax Act, 1961) computed in accordance with
to my/our consent, the Bank may outsource or the provision of Income Tax Act, 1961 for the

1
 financial year in which the above transaction is held will Banking and Mobile Banking services on terms and
be less than maximum amount not chargeable to tax. conditions of Internet Banking services, Phone Banking
15. I/We undertake to provide/inform the Bank of any change and Mobile Banking as available/set forth on the Website
to the KYC documents provided by me, including change and I/we agree to abide by the same. I/We understand
in the communication address. I/We authorize the Bank that to revoke the usage of the above services, I/we shall
to update the same in their records. In case of any have to issue a letter of revocation to the Bank in this
failure/delay in intimating the changes on my/our part, regard. I/We agree that until ten days after receipt of such
the Bank disclaims all liabilities resulting from such loss revocation letter, the above authorization shall hold
or damage caused to me/us. good. The Terms and Conditions of Debit Card Member
16. I/We undertake, agree and confirm: a. That I/we are not agreement governs the use of my/our card(s).
and have not any insolvency, bankruptcy and similar 23. For Joint Account (if applicable)
proceedings initiated against me/us nor I/we have been I/We joint holder/s, hereby authorize the primary
adjudicated insolvent; b. The Bank or its agents to make applicant, to access the Internet Banking, Phone Banking
references and enquiries related to information in this and Mobile Banking channels as provided by the Bank
CAF which the Bank or its agents consider necessary for and I/we agree that the Bank shall not be held liable for
the purpose of account opening, verification with respect acting upon the instructions of the primary applicant or
to KYC and/or Anti-Money Laundering (AML). any errors, liability, negligence, defaults, or omission that
17. I/We hereby agree and authorize the Bank to reverse any occur due to the above authorization.
erroneous credit given to my/our account/s and/or to 24. I/We hereby confirm that all accounts under this
reverse any such amounts of which I/we am/are not the Customer ID are operated singly and in case of Joint
intended recipient. I/We undertake not to hold the Bank account operated by either or survivor/anyone or
or its agents/ representatives liable (in any manner survivor.
whatsoever) for any such reversal made to my/our 25. This CAF together with the EAF, Tariff guide/Charges
accounts at any point in time. applicable and the Terms for [NRE/NRO Savings
18. I/We hereby consent to receiving information from Account] and other terms and conditions as available on
Central KYC Registry through SMS/e-mail on my the Website constitute the account opening documents
registered mobile number/e-mail ID. for the above referred account.
19. I/We authorize the Bank to receive/extract 26. I/We shall not make available to any person resident in
information/credit score pertaining to my/our credit India, foreign currency against "reimbursement“ in 'INR'
worthiness/ credit score from credit rating agencies for or any other manner in India. I/We understand and
the purpose of account opening and for offering various acknowledge that in case I/we instruct the Bank for any
products and services by the Bank. conversion of my/our remittance/s from one currency to
20. Disclosures another, either for booking of a deposit or for such other
I/We hereby expressly authorize and give consent to the permissible purposes as permitted under FEMA, the
Bank to share, exchange, disclose, transfer or part with currency conversion risk shall be solely borne by me/us.
any of my/our account information or personal data, 27. Declaration for customer of NRI Account/Program:
contained in this CAF or in the EAF or otherwise provided I/ We have read other terms and conditions of NRI
to/ available with the Bank, when the bank considers Account/Program and other products and service specific
such disclosure as necessary or expedient, with: terms and conditions available and updated on the
Employees or agents of the Bank, group entities, Website from time to time and I/we agree to abide and be
a. subsidiaries, branches in any jurisdiction; bound by them.
Auditors, any agencies/credit bureaus, any court or 28. In case of Pakistan's Citizens, I/we have obtained specific
b. tribunal or any statutory, regulatory, judicial, approval from RBI to open the accounts for NRI and a
governmental, or administrative authority Central KYC copy of the same has been submitted along with my/our
registry, SEBI Know Your Client registration agency CAF and EAF.
having jurisdiction over the Bank or its group 29. Money2India Declaration:
entities/subsidiaries/branches; a. I hereby authorize the Bank to use any/ all information, as
Service providers or any such person with whom the contained in this Customer Application Form, for the
c. Bank contracts or proposes to contract in relation to the purpose of registering on Money2India services on my
provision of services in respect of the account or behalf for all geographies as updated on the Bank’s
facilities; for the purpose (i) of compliance with website from time to time. If I wish to opt out of
applicable laws or any order (judicial or otherwise), Money2India services, I would write to
statutory or regulatory requirement or (ii) of facilitating nri@icicibank.com from my registered Money2India
banking transactions through any medium (whether e-mail ID stating the same.
through Internet Banking, Phone Banking, Mobile b. We, hereby authorize ICICI Bank UK PLC (wholly owned
Banking or otherwise) or (iii) disclosures for credit review subsidiary of the Bank) to use any/ all information, as
of any account, assets or service or any credit facilities contained in this application form, for the purpose of
received/availed/held bythe customer from the Bank opening Money2India Europe account on my/our behalf.
(whether singly or jointly or otherwise) or (iv) for I/We understand that Money2India Europe account is a
authentication or verification purposes, or (v) research or default service offered to me/us with NRI account and is
analytical purposes, credit reporting, credit scoring, risk currently offered in <20> countries in Europe and
management, participation in any telecommunication or maybe extended to other geographies as updated on
(vi) electronic clearing network and for use or processing Money2India Europe website from time to time.
of the said information/data. Money2India Europe account is a service offered by ICICI
21. I/We hereby undertake and confirm that I/we have read Bank UK PLC, Germany Branch. For more information,
and understood and hereby agree to the Privacy Notice please visit www.money2india.eu.
as provided under/made available to me/us at the 30 FATCA/CRS declaration
Bank’s website, I/We understand/ agree (i) that Bank is relying on this
https://www.icicibank.com/nri-banking/RHStemp/privac information for determining the status in FATCA/CRS
y-notice-eu-users.page. compliance that the Bank is not able to offer any tax
22. I/We hereby authorize the Bank to issue ICICI Bank Debit advice on FATCA/CRS status or its impact; (ii) to submit
Card and enable provisions of Internet Banking, Phone a new form within <30> days if any certification or

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 information in the FATCA/CRS becomes incorrect; (iii) 34. I/We hereby confirm the responsibility for maintaining a
that as may be required by domestic regulators/tax Monthly Average Balance (“MAB”) during any financial
authorities, the Bank may also be required to inform year month. Failure to maintain the prescribed MAB may
reportable details to CBDT or close or suspend my/our attract service/MAB charges and such charges may be
account/s. deducted by the Bank from my/our account(s) held in
31. Aadhaar Consent: my/our customer ID.
I/we have been explained and informed in the local 35. I/We hereby acknowledge and confirm that the Bank will
language understood by me/us about the consent and not be responsible for any loss or damage due to loss or
purpose of collecting Aadhaar. I/We have been informed miscarriage of the cheque(s) or of any delay in collection,
that: transmission and otherwise of any remittance
a. upon authentication, UIDAI may share with the Bank howsoever caused. If any instrument(s) for collection
information in nature of my /our demographic is/are returned unpaid at any time the returning and
information including photograph which the Bank may changes may be debited to my/our account. If any
use as an identity/address proof for the purpose of cheque/draft credited to my/our account provisionally
account opening; prior to final realization under the Bank’s special cash
b. my/our Aadhaar details (including my demographic letter services is return unpaid, the amount may be
information) shared by UIDAI will not recovered from my/our account at the appropriate
c. be used for any purpose other than the purpose exchange rate along with interest applicable at such
mentioned above or as per requirements of law; rates as may be decided by you. I/We undertake to
d. my/our biometric information will not be stored by the refund the amount, if already drawn by me/us,
Bank. immediately on demand if our account does not have
32. Politically Exposed Persons (PEPs) sufficient balance to recover the amount with interest
Politically exposed person are individuals who are or and/or any other changes.
have been entrusted with prominent public functions in a 36. I/We agree that the Bank shall not be obligated to verify
foreign country. Examples of PEPs include, but is not the identity of the person giving Instructions and/ or
limited to: (i) Heads of States or of Governments (ii) Documents or verify the authority given to such person,
Senior politicians (ii) Senior government /Judicial which the Bank in good faith considers to be that of any
/Military officers (iv) Senor executives of state - owned person authorized by me/us.
corporations (v) Important political party officials (vi) 37. I/We agree that the Bank shall be entitled (but not
Senior Indian Diplomatic posted outside the country. The obliged) to keep records of the Instructions/ Documents,
term PEP also include the families and close associates as the Bank may deem fit, and these records shall be
of the PEPs mentioned above. conclusive and binding on me/us. Further, the Bank shall
Families: The term families include close family be entitled to dispose of or destroy any such records at
members such as spouse, children, parents and siblings any time as determined by it in its sole discretion.
and may also include other blood relatives and relatives 38. I/We agree that the Bank shall be entitled to require any
by marriage. instruction in any form to be authenticated by use of any
Close associates: The terms closely associated persons password, identification code or test as may be specified
in the context of PEPs includes close business and from time to time and I/ We shall ensure the secrecy and
personal advisors /consultants to the PEP as well as security of such password, code or test and I/We shall be
persons who benefit significantly from being close to solely responsible for any improper use of the same.
such a person. 39. I/We agree that, notwithstanding anything contained
33. Declaration of Indemnity herein, the Bank may, at any point of time, require from
I/We agree to hold the Bank, its directors and employees, me/ us confirmation of any Instructions and/or
representatives, agents, it’s customer’s or any third party Documents in such form as ICICI Bank may specify
as the case may be, indemnified against all direct or before acting on the same.
indirect actions, suits, proceedings, claims, demands, 40. NCCT Country declaration (as applicable):
losses, damages, costs, charges and expenses suffered, I hereby confirm that all details submitted above are true
arising from: and verified and in case of any due diligence requirement
a. The Bank acting or not acting on the basis of any of the will provide relevant documentary evidence to Bank
below, whether such information/documents have been 41. Declaration about Existing Relationship with Bank
confirmed by me/us in writing or not; I/We hereby agree, confirm and authorise ICICI Bank Ltd,
i. instructions given by me/us (including but not limited to India (ICICI Bank) to re-designate the resident Savings I
fax and other telecommunications or electronic Current Account(s) & term deposits, if any, held my me
instructions), or persons purported to have been with ICICI Bank. at any point of time as deemed fit by
authorized by me/us; ICICI Bank into Non-Resident Ordinary (NRO) Accounts/
ii. information/documents submitted by me/us; deposits as the case may be.
b. Any misrepresentations vis-à-vis information provided I have been informed that:
for account opening, breach of any terms, conditions, A. lf the resident account is held in the same Mode Of
declarations, representations, undertakings and Operation (MOP) as that of the account (the new
warranties contained in this CAF/EAF/Terms for Non-Resident account opened), and the second
[NRE/NRO] Savings Account and other terms on the applicant continues to be a resident Indian, then the
Bank’s website; consent of the primary account holder is sufficient for
c. Any fraud, negligence or misconduct by me/us; re-designation. The mode of operation of such accounts
d. Any negligence on the part of the customer by sharing will be updated to former or survivor.
payment credentials, delay in notifying the Bank of any B. If the Account and the resident account being
unauthorized electronic banking transaction; and re-designated are held in title same MOP with both the
e. Exercising the Bank’s right of set-off, combination, account holders being NRls, then title consent of title
consolidation, lien or any other right. primary account holder is sufficient for re-designation.
The indemnity stated herein shall be in addition to and C. The existing Debit Card on the resident account will be
not in derogation of any other indemnity obligation cancelled and a new domestic Debit Card shall be issued
undertaken by me/us whether stipulated in the Terms for for the NRO Account. Customer can continue to use the
Savings Account or otherwise. existing cheque book.

3
 D. If there is a change in the MOP or if there ia addition of document & identity verification.
Joint Applicant(s) in the resident account being 44. I/We confirm that these confirmations/declarations/
re-designated then a separate re-designation request undertakings given by me/us are true, correct and not
needs to be submitted with signatures of all account misleading and that I/we have read and fully understood
holders being NRIs. the Bank's Terms and Conditions governing NRE/ NRO/
E. If the NRI customer is a joint holder, not being the FCNR/RFC accounts and all other terms and conditions
primary holder, in a resident account, then the resident as available for “NRI Banking” on the Website
account shall not be re-designated into NRO account. (www.icicibank.com/nri-banking/nri-banking) in respect
The customer will need to submit instructions for of all products, services and channels offered by ICICI
deletion of his/her name from resident account. Bank to NRIs/ PIOs in relation to the Accounts (collectively,
F. Request you to de-link Invest@ease facility from the “Terms and Conditions”
Resident Savings Acccount because my/our residential 45. I-direct Related:
status has changed to NRI and the Resident Savings • I hereby confirm and agree that on conversion of my
Account needs to be converted to NRO. bank account held by me in my resident Indian capacity,
G. iWish RDs: I Wish RDs will be closed and credited to into NRI account, my ICICI Direct account, if any, shall be
your linked converted NRO savings delinked with the former viz. my resident bank account
H. PPF Account Related: and ICICI Direct account shall remain suspended till it is
Please note, incase if we observe a PPF account in your converted in NRI status.
customer ID : • I hereby authorize ICICI Securities to cancel all my active
• If the date of opening of PPF Account is prior to date of Equity /MF/NPS -SIP/STP/SWP/TIP for conversion of
becoming NRI then PPF Account will be converted to NRI Bank account from SB to NRO. Please note on
status. You can contribute towards PPF Account on cancellation of ongoing SIP, trading account will be
non-repatriation basis. PPF Account shall be continued temporarily closed before conversion of Bank account
till maturity but extension of account is not allowed as from SB to NRO.
per scheme rules.
• If the date of opening of PPF Account is later than the
date of becoming NRI then linked PPF Account will be
closed and no interest shall be payable to the customer
from the date of opening of PPF Account.
I. PM Schemes like Atal Pension Yojna (APY), Pradhan
Mantri Jeevan Jyoti Bima Yojna (PMJJBY), Pradhan
Mantri Suraksha Bima Yojna (PMSBY), Sukanya
Samruddhi Yojna (SSY)
Schemes will cease to be in effect since non-residents
are ineligible for these schemes
Please arrange to cancel any Standing instructions linked
to these accounts.
42. The Person of Indian Origin (PIO) /Overseas Citizen Of
India (OCI) Declaration
I hereby declare that I am a person of Indian Origin and I
satisfy one of the following conditions. (Please pick the
choice) applicable to you:
a. Primary applicant
I Held an Indian Passport in the past
My father/mother / grandfather/ grandmother
(name)______________________________________ is/was
a citizen of India by virtue of the Constitution of India or
the Citizenship Act, 1955
I am the spouse of an Indian Citizen
The father/mother / grandfather/ grandmother
(name)_______________________________________ of my
spouse is/was a citizen of India by virtue of the
Constitution of India or the Citizenship Act, 1955
b. First Co-applicant
I Held an Indian Passport in the past
My father/mother / grandfather/ grandmother
(name)_______________________________________ is/was
a citizen of India by virtue of the Constitution of India or
the Citizenship Act, 1955
I am the spouse of an Indian Citizen
The father/mother / grandfather/ grandmother
(name)________________________________________of my
spouse is/was a citizen of India by virtue of the
Constitution of India or the Citizenship Act, 1955
43. I/ We hereby agree and authorize ICICI Bank to share my/
our information, documents and other relevant details
provided by me/ us to ICICI Bank for opening NRE/ NRO
Account with the Identity and/or Credit verification
agencies for the purposes of performing online

4
 Form 60 of Primary Applicant

Middle M M Y Y Y Y
Name
Surname

3 First
Name
Middle
Name
Surname

6 Name of Premises

Area/Locality

11 State

13 PIN code Mobile number

16

M M Y Y Y Y transaction

Cash, Cheque, Card, Other

M M Y Y Y Y

Code number document

Code number document

Verification

belief. I further declare that I do not e a Permanent Account Number and my/ our estimated total income (including income of spouse, minor
child etc. as per section 6 of Income-tax Act, ) computed in accordance with the s of Income-tax Act, 1 for the financial year
in which the e transaction is held will be less than maximum amount not chargeable to tax.
Verified today,
Place:
Signature of the 1st Applicant
Note:
1. Before signing the declaration, the declarant should satisfy himself/herself that the information furnished in this form is true, correct and complete

(i)

(ii)
fine.

5
 Form 60 of First Co-Applicant

Middle M M Y Y Y Y
Name
Surname

3 First
Name
Middle
Name
Surname

6 Name of Premises

Area/Locality

11 State

13 PIN code Mobile number

16

M M Y Y Y Y transaction

Cash, Cheque, Card, Other

M M Y Y Y Y

Code number document

Code number document

Verification

belief. I further declare that I do not e a Permanent Account Number and my/ our estimated total income (including income of spouse, minor
child etc. as per section 6 of Income-tax Act, ) computed in accordance with the s of Income-tax Act, 1 for the financial year
in which the e transaction is held will be less than maximum amount not chargeable to tax.
Verified today,
Place:

Note:
1. Before signing the declaration, the declarant should satisfy himself/herself that the information furnished in this form is true, correct and complete

(i)

(ii)
fine.

6
 Most Important Information

I/We refer to the application form no.______________________________submitted

3619666 by me/us to ICICI Bank Limited for NRE / NRO account.
I/We have accepted and agreed to the following information that has been provided to me/us.

Please Tick any NRI Product/ Monthly Average Balance Non-Maintenance

Debit Card
one option Program (MAB##) requirement of MAB charges#
annual fees#
below variant

NRI Regular • INR 10,000 at Account level Or 6% of the shortfall in required MAB INR 299 for NRI
/Minor Account • INR 25,000 at Customer ID level or INR 500, whichever is lower. Silver debit card

NRI Pro Program • INR 2,00,000 at CASA level Or 3% of the shortfall in required MAB Nil for
✔ • INR 5,00,000 at CASA + Deposit Or or INR 500, whichever is lower. NRI Platinum
• INR 25,00,000 at CASA + Deposit + debit card
Loans* + Demat** +
Credit card spends*** Or
• INR 50,00,000 at Home loan~

NRI Premia • INR 5,00,000 at CASA level Or 2% of the shortfall in required MAB Nil for NRI
Program • INR 25,00,000 at CASA + Deposit Or or INR 500, whichever is lower. Infinite/World
• INR 50,00,000 at CASA + Deposit debit card
+ Loans* + Demat** +
Credit card spends*** Or
• INR 1,00,00,000 at Home loan~

#
GST applicable
##
Minimum balance requirement
*ICICI Bank disbursed value of Auto loans, Education Loans, Personal Loans, Loan against Securities, Loan on Mutual Funds
**Only equity portfolio
***Average spend of credit cards of last 12 months
~ICICI Bank disbursed value of Home loans
Account level: Minimum average balance maintained in each Saving/Non-interest bearing account under same Customer ID.
CASA level: Cumulative minimum average balance in all Saving/Non-interest bearing accounts under same customer ID.
Customer ID level: Cumulative minimum average balance in all Saving/Non-interest bearing accounts under same
customer ID + Month end FD/RD balance.
I/We acknowledge that:
1. I/We have gone through the ‘new customer’ section and the schedule of charges as updated on the Bank's website
www.icicibank.com/nri
2. Any other charges that are not mentioned herein above but are provided on the Bank's website www.icicibank.com/nri shall
be applicable to me/us.
3. I/We shall be governed by the terms and conditions applicable to the aforesaid account and it shall be my/our responsibility
to obtain and read a copy of the terms and conditions.
4. The charges and terms and conditions mentioned herein above and in the User Guide are subject to revision from time to
time, notice of which shall be provided by ICICI Bank in its website www.icicibank.com/nri.
5. I/We am/are aware that there is a change in Schedule of Charges applicable for ICICI Bank NRI Savings / Non-interest
bearing Accounts effective June 1, 2016. I/We understand that ICICI Bank has revised its minimum average balance
requirement for NRI savings and non-interest bearing accounts from Quarterly Average Balance (QAB) to Monthly Average
Balance (MAB) and I/We agree to be bound by the same.

ANNEXURES

ANNEXURE 3- SIGNATURE MISMATCH VERIFICATION

With reference to my documents and the application form I have submitted herewith, I request you to record with
yourselves my specimen signature as given in the application form. While the signature appearing in the document
submitted as proof is different. This difference in signature is because
__________________________________________________________________________________.

Signature of 1st applicant: _____________________________ Signature of 2nd applicant: ___________________________

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 ANNEXURE 2G- BLOOD RELATIVE DECLARATION (If the address proof is in the name of a relative who is not an
applicant to the account)

I/We hereby solemnly declare that I stay with Mr. / Ms. _____________________________________________________. The
proof of my current / permanent address as mentioned on the account opening form is in the name of my Spouse /
Brother / Sister / Parent (father / mother) / Child (daughter / son) and I am encloFormsing a proof of relationship. I/ We,
solemnly affirm that my/ our current / permanent address is as mentioned in the Account Opening . The information given
is correct and nothing has been concealed. I am aware it is illegal and a criminal offence to deliberately furnish false
information or suppress information. I undertake to be entirely responsible for any loss/ expenses incurred by the bank on
account of relying on my declaration.

Signature of Primary Applicant: ________________________

Declaration by the Address Proof Holder:
I, the address proof holder solemnly affirms that I, have no objection to allow the primary applicant to use my address for
bank communication purposes. The said primary applicant resides with me at my residential address for which I have
provided a valid proof as per banks requirements. The information given above is correct and nothing has been concealed
and I am aware it is illegal and a criminal offence to deliberately furnish false information or suppress information.

Signature of address proof holder: _______________________

ANNEXURE 2L- DECLARATION FROM CUSTOMER FOR CHECKING E-VISA DETAILS

With regard to my application for opening NRE/NRO account, for proving NRI status, I have submitted e-Visa, which was
downloaded from the website Immigration site, www.______________________ of ___________________ immigration
authority.
I hereby authorize ICICI bank to download/check the details through the said site by using the pertinent details submitted
by me/provided herein,

Primary Applicant First Co-Applicant

E-Visa number/Unique Number: _______________________ E-Visa number/Unique Number: ________________________
Other details for viewing Visa: _________________________ Other details for viewing Visa: __________________________
Signature of 1st applicant: _____________________________ Signature of 2nd applicant: ____________________________

SIGNATURE AND PHOTOGRAPH

I/We have read and understood the declarations governing the above products and confirm the details provided
(Please sign in black ink within the box)

Signature: Primary Applicant/Guardian Joint/Co- Applicant 1 Joint/Co- Applicant 2

(Signature Primary (Signature Joint/

Applicant/Guardian) Co- Applicant 1)

(Please ensure that your signature matches with the signature on the passport/funding cheque)

Name: (Name Primary

Muskaan Jitesh Applicant/Guardian)
Jiwani (Name Joint/Co- Applicant 1) ( )

(Please affix a recent photograph)

Photograph:

Primary Joint Applicant 1/ Joint Applicant 2/

Applicant Co-Applicant 1 Co-Applicant 2
Photograph Photograph Photograph

In case you are not meeting any ICICI Bank Official and your signature differs from passport, you can
Submit a government issued photo identity document having your signature (Driving License, Residence Card, etc.) OR
Your new signature can be attested by a Banker/Indian Embassy/Notary (OR equivalent of Notary as per applicable laws)
Important points:
1.The stipulated Monthly Average Balance (MAB) based on the product/program variant should be maintained in all accounts.
2. In case of non-maintenance of the stipulated MAB. charges as specified from time to time will be applicable.
3. Savings Accounts opened must not be used for business purposes.
4. In case of unsatisfactory conduct of the account, Bank reserves the right to close the account.
5. It is important that correct profile details are provided in the form, so that it matches with the transaction pattern and balances in the account. Bank may review
the transaction pattern in your account based on the information provided, which would be used to report transactions of suspicious nature, if any.