For Office Use Only Service Request No.______
NRI Customer Request Form (for Personal Details Updation) FORMS (To be submitted only to a Branch, with photocopies of self-attested valid passport/relevant documentary proof of all account holders)
Date: D D M M Y Y Y Y
To, ICICI Bank Ltd., The Branch Manager
Branch ......
Name/s of the Applicant/s:
Customer ID: Account Number:
Existing Contact No. : ……………………………………………………… Update New Contact No...... (Country Code +Area Code +Number)
Existing Mobile No. : ………………………………………………………....Update New Mobile No...... (Country Code +Number) I want to apply for ICICI Bank Mobile Banking Service in respect of my account(s), as mentioned above I wish to subscribe to all the alerts as are displayed on the website www.icicibank.com as applicable to my account(s).
Existing Email Address: ………………………………………………….. Update New Email Address: ...... (I confirm having checked my Email address and understand that all email alerts (one time password etc.) will be sent on above mentioned Email Address.)
I would also like to subscribe for E-statement facility on new email id mentioned above.
Please perform the modifications in my account as indicated below. (All fields are mandatory. Please √ appropriate boxes and give complete details.)
Please activate inactive account(s) under my Customer ID.
Please update my Name/Surname in the account (the document as proof of change is enclosed).
First Name Last Name
Please update my Date of Birth: D D M M Y Y Y Y (the document /photocopy of valid Passport is enclosed).
Please update my Mother's Maiden Name:
Please update my PAN No. : (a photocopy of my PAN card is enclosed)
Update New Passport No. : Expiry Date : D D M M Y Y Y Y
Existing Passport No. : Expiry Date : D D M M Y Y Y Y
I wish to update my new Signature in the account. My new Signatures are appended below-
My old Signature My New Signature (as per Bank's record) (Please sign inside the box) (Please sign inside the box)
Notes : 1. In case you are able to replicate your old signatures, there is no proof required. 2. If you are unable to replicate your old signatures, we request you to submit any one of the following document : a) Any government issued photo identity document (Driving license, Residence Card etc.) having a seal/stamp of Government authority as a proof of current signature, duly attested by a Banker or Indian Embassy or Notary. The signature on the form should match the signature on the government issued document. b) Declaration stating “ I hold an NRI Bank account with ICICI Bank (name of the city) branch and am unable to replicate my old signatures. Kindly attest my signatures.” should be attested by a Banker or Indian Embassy or Notary. The Banker/Embassy/Notary can mention “verified with records”/signed in my presence”/ “signature verified” or equivalent. c) If self-attested copy of the passport is notarized the same can be accepted as proof of new signature.
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PSTUDIO2_ICICI_10460306_SK_Customer Request Form_Size 210 mm (w) x 297 mm (h) Declarations : 2. Account Activation
• I agree to update my emailPlease ID/contact activate numbers inactive mentioned / dormant above account(s) in the bank's under records my forCustomer any further ID. correspondence. • I agree that if my account mentioned above is inactive, it will be activated on the basis of this request form. • I agree that in case3. my/ourPersonal Passport details details are not available with the bank, photocopies of my/our passports submitted with this application will be used to update the records.
• I/We hereby agree that we Please have readupdate and my understood Name/Surname the terms inand the conditions account and (the instructions document available as proof at icicibank.com/nriof change is enclosed). or/and Customer requisition form from time to time that apply to and regulate the operation of the products and services and facilities mentioned herein above.
• An email alert would be sent at your registered email id confirming the status of your request. First Name Last Name
Please update Firstmy Date Applicant of Birth: Joint Applicant (the document1 /photocopy ofJoint valid Applicant Passport is2 enclosed).
Signatures Please update my Mother's Maiden Name: (as per bank’s records)
To be filled in by the Branch Please (in case update of a changemy PAN in No.signature : or if signature/s are not currently scanned into the (a system):photocopy of my PAN card is enclosed)
I confirm that I have4. Requestverified the for identity TDS Certificates of the above-named and Bank person/s statement and he/they have signed in my presence. I authorise the updation of his/their signature/s in the system.
Signature ID:...... Please provide detailed Employee statement No:...... for the period from Signature of Authorising Official:...... to
Designation:...... TDS certificate for NRO Account(s) Name of Authorising in my Customer Official:...... Id for the Assessment Year for Quarter ......
5. Deliverables Related
Acknowledgement PleaseSlip send the following deliverables to my existing / new communication address mentioned above in point 5:
Received From: ...... Cheque Book Internet Account Banking Number: user id ...... Internet Banking Password
Acknowledgement for: ...... Reissue of ATM/Debit Card : Name of Applicant……………………………………...... Ref. No.: ...... Dated: ...... ATM/Debit Card Pin Card No. : Signature: ...... Name of Signing Officer: ...... (If requested card is in temporarily blocked status, kindly unblock the same and then issue a ATM/Debit Pin) ICICI BANK I have attached a valid address document as proof of the change of address (refer to the list of valid address proof attached). Name: ...... Stamp:
6. Upgrade your Debit Card : List of Acceptable Documents (1) Existing Card Number:…………………………………...... Document NRI ID Proof ID Proof Indian Oversea Relationship (2) Type Of Card: Silver PlatinumStatus Worldfor NRI Debit Cardfor Address Address Proof Proof Resident Proof Proof • International debit card is issued for NRE Accounts. NRO account holders are eligible only for a domestic debit card. Valid Indian passport with photo and signature No Yes Yes Yes Yes Yes • Your request for Issue of ATM/Debit Card will be processed within 4 working days. You will receive the card within 7 days from the date of In case of PIOs : Foreigndispatch. passport having Yes Yes No No No No parents’ / spouse’s• name Annual fees of INR 299/- (plus service tax) for Platinum Debit Card and INR 399/- (plus service tax) for will be levied. Charges are subject to change without prior notice. In case of NRIs : Valid Visa/ Work Permit/ Resident Card Yes No No No No No • ATM/Debit Charges of INR 375/- (plus Service tax) will be applicable for deliveries outside India. In case of PIOs : PIO• card/ Card OCI will card be sent to the communication address as Yesavailable in theNo Bank records.No No No Yes • In case you have requested for a change of address, we advise you to place this request upon successful updation of address. Utility Bills : (Electricity, Land line, Piped Gas, Water Connection) No No No No Yes No • If you have provided your mobile number or e-mail ID, we will inform you about the closure of your request by SMS or e-mail respectively. not older than 2 months Providing the mobile number or e-mail ID here will not result in an update of your mobile number or e-mail ID as recorded with us. Bank Statement / Post• office ICICI Banksaving does bank not account take any statement responsibility, and will also not be liable, for your claims if the details provided by you are incorrect/incomplete. ( Showing 2 customer induced transactions - not older No No No Yes Yes No than 3 months from the date of account opening)
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PSTUDIO2_ICICI_10460306_SK_Customer Request Form_Size 210 mm (w) x 297 mm (h) List of Acceptable Documents
Document NRI ID Proof ID Proof Indian Oversea Relationship Status for NRI for Address Address Proof 7. Block and Unblock Debit/ATM Card : Proof Resident Proof Proof
Block Card PAN card issued by the Income Tax Department StatusNo of the Card:...... No Yes No No Yes Unblock Card* Status of the Card:...... Driving License bearing the photo & the expirt date No No Yes Yes Yes No (* Permanent blocked cards cannot be unblocked) Marriage Certificate No No No No No Yes 8. Open additional NRE/NRO Savings Bank Account Leave and License agreements / Letter for accommodation (An agreement made with employers being State or Central Please open an additional: NRE Savings Account NRO Savings Account Government departments, statutory or regulatory bodies, public Open NRE/NROsector SB accountundertakings, in same scheduled branch commercial banks, financial No No No Yes Yes No institutions and listed companies can be accepted as a valid Open NRE/NROoverseas in another address Branch proof...... (mention If a letter of accommodation has been Branch Code and Name) issued by such employer, then the same can be accepted as I/ We have attached photocopies of my/our Passport/s that is/are required to open an additional Savings Bank Account.(refer to point 2 in Notes) a valid overseas address proof.) *Pan Details: Documents issued by government departments of foreign jurisdictions Pan Number (Valid ID Documents issued by a Government authority having Form the 60 No No No Yes Yes No customer’s name, and address, e.g. National ID card,.etc) Pan Ackn No. ______Marriage Certificate No No No No No Yes Pan Ackn Date: ______Agriculture income: ______Non Agriculture income: ______Leave and License agreements / Letter for accommodation # If Form 60 is selected(An then,agreement Income made details with are employers mandatory. being If Total State income or Central is greater than or equal to 2,50,000, then Pan Ackn No. is mandatory Government departments, statutory or regulatory bodies, public Notes sector undertakings, scheduled commercial banks, financial No No No Yes Yes No institutions and listed companies can be accepted as a valid 1. The request has to be signed by all the applicants. overseas address proof. If a letter of accommodation has been 2 If any applicant’sissued passport by such has employer,expired or thena new the passport same can has be been accepted issued as to any applicant after the account was opened with the bank, please provide acopies valid overseasof the valid address passport. proof.) 3. A funding cheque of `15,250 has to be provided, if the existing Customer ID balance is below Rs. 25,000. Documents issued by government departments of foreign jurisdictions 9. Transfer of Savings(Valid Bank ID Account Documents (including issued linkedby a Government Flexi-fixed Deposits*authority having to another the branch)No (*Earlier known No as QuantumNo Optima)Yes Yes No customer’s name, and address, e.g. National ID card,.etc) I, the existing account holder with ...... Branch request you to transfer my account to ...... Property or Municipal Tax receipt No No No Yes Yes No ...... Branch (mention Branch Code and Name).
Purpose of transfer: Voter’s...... ID Card No No Yes Yes No No
Job card issued by NREGA duly signed by an Notes : No No Yes Yes No No officer of the State Government • I understand that my request for Transfer of Account is applicable to my Savings Account and Flexi-fixed Deposits (if any) linked to it. Aadhaar letter card issued by Unique Identification • I understand that my account number/s will remain unchanged after transfer to the BranchNo requested for. No Yes Yes No No Authority of India (UIDAI) • I understand that all cheques payable at par issued by me in my Savings Account can be used after the transfer. • I understand thatBirth I have Certificate separately request for transfer of my stand-alone Demat Account (ifNo linked to the No above SavingsNo Account).No No Yes • I will continue to use the existing ATM/Debit Card (if the card has expired, a new card will be issued). Ration Card No No No No No Yes • I-Direct linked accounts: I confirm that I have removed lien, if any, in the account. I understand that if there is a lien/freeze on my account/s, such accounts will not be transferred. Matriculation Certificate No No No No No Yes • I understand that if my account is in debit balance, I must regularize the account before the request is processed. School leaving Certificate No No No No No Yes 10. Home loan Linked NRI Saving a/c (Note: KYC documents not require for change in product variant): Court Affidavit No No No No No Yes Please Change my/our savings account product variant from NRE/NRO Saving Account to Zero Balance NRE/NRO Saving Account for Home loan. Life Insurance policy No No No No No Yes 11. Signature Updation Pension or family PPOs No No No Yes No No
I wish to update my new Signature in the account. My new Signatures are appended below-
My old Signature My New Signature (as per Bank's record) (Please sign inside the box) (Please sign inside the box)
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PSTUDIO2_ICICI_10460306_SK_Customer Request Form_Size 210 mm (w) x 297 mm (h) For Bank use only – Checklist of Branch/RPC
Item to be checked Action to be initiated by the Branch Tick for verification by the Branch
Activation of Notes : • Check Customer Signature Signature verified and authorised Inactive Account 1. In case you are able• Check to replicate if Account your is active,old signatures, is not under there lien is no/ proof Recoverrequired. lien amount freeze 2. If you are unable to replicate your old signatures, we request you to submitLien / Freezeany one removal of the following approved document : Personal Details (DOB/ a) Any government• Account issued should photo not identity be inactive document / Dormant (Driving license,Account Residence status Card checked etc.) having a seal/stamp of Government authority as Mother Maiden Name / a proof of current• Primary signature, applicant duly to attestedsign the byrequest a Banker for or Indian EmbassySignature or verified Notary. and The authorised signature on the form should match the Passport No. / Contact signature on updation.the government issued document. No./Mobile no.) Supporting documents checked and stamped with b) Declaration• stating The necessary “ I hold an documents/photocopy NRI Bank account with duly ICICI Bank (name“Verified of thewith city) original” branch and am unable to replicate my old signatures. verified and stamped. Kindly attest my signatures.” should be attested by a Banker or IndianNA Embassy or Notary. The Banker/Embassy/Notary can mention “verified with• Passport records”/signed copy in my presence”/ “signature verified” or equivalent. Pan Updation c) If self-attested• Account copy of should the passport not be isinactive notarized / Dormant the same can be Accountaccepted status as proof checked of new signature. • Primary applicant to sign the request for Signature verified and authorised updation. Details checked on PAN Site Declarations : • Updation of Pan details to be done only after checking authenticity of PAN Number and • I agree to update myname email ID/contacton Income numbers Tax Department’s mentioned above website in the bank's records for any further correspondence. • I agree that if my account(http://incometaxindiaefiling.gov.in/knowpan/- mentioned above is dormant/inactive, it will be activated on the basis of this request form. knowpan.jsp). • I agree that in case my/our Passport details are not available with the bank, photocopies of my/our passports submitted with this application will be used to Registration of Mobileupdate the records.• Primary applicant shall place request for Request given by primary applicant Banking Alert (only• on I am Indian aware that all deliverablesMobile banking will be alerts.sent only to the updated communication address in the bank’s records. numbers) Account status checked • I/we agree to update• Customer my/our current Account signature/s should appended be in active below status. in the bank's records in case there is any major deviation in signature/s (*proof of new signature attached) NA • Customer's account to be checked if he has • II/We hereby agree that we have read and understood the terms and conditions Countryand instructions code checked available at icicibank.com/nri or/and Customer requisition form from time to time thatregistered apply to and for regulate this facility. the operation of the products and services and facilities mentioned herein above. • An email alert would• Country be sent at Code your isregistered mandatory email id confirming the status of your request. Email Updation • Primary applicant shall place request for Request given by primary applicant Mobile banking alerts.First Applicant Joint Applicant 1 Joint Applicant 2 Account status checked • Customer Account should be in active status. Signatures Recover lien amount • Check if Account is active, is not under lien / (as per bank’s records) Lien / Freeze removal approved freeze Registration for E-statement • Account should not be inactive / Dormant Account status checked To be filled in by the• PrimaryBranch (in applicant case of a tochange sign inthe signature request or for if signature/s areSignature not currently verified scanned and into authorised the system): updation. NA I confirm that I have verified the identity of the above-named person/s and he/they have signed in my presence. I authorise the updation of his/their signature/s in the system. • Default “R” t be updated unless there is a specific request fom customer
Signature Updation Signature ID:...... • Request letter has to be Employee signed No:...... by all Signature verified Signature and authorised of Authorising Official:...... applicants. Verify old and new signature Designation:...... • Request to be submitted having Name old of andAuthorising new Official:...... BM / BOM authorisation obtained for variation signature. Passport copy obtained
1. I confirm Acknowledgementthat I have verified the Slip identity of the above-named person/s and he/they signed in my presence. I authorise the updating of his/their signature/s in the system. (In case ofReceived dormant/inactive From: ...... accounts): Account Number: ...... 2. I confirm the activation request for dormant/inactive account was received from a genuine source, by verifying the identity proofs. Authorization by BranchAcknowledgement Head / Branch for: Operations ...... Manager only.
Ref. No.: ...... Dated: ...... Name: ......
Signature: ...... Name of Signing Officer: ......
...... ICICI BANK SIGNATURE OF AUTHORISING OFFICIAL Employee ID: ...... Name: ...... Stamp:
(BM Authorization Mandatory)
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PSTUDIO2_ICICI_10460306_SK_Customer Request Form_Size 210 mm (w) x 297 mm (h)