ICICI Bank Credit Cards SUPPLEMENTARY CREDIT CARD APPLICATION (Liability of the Supplementary Credit Card will be on the Primary Card Member) PRIMARY CARDHOLDERS DETAILS: Name Card Account: ‘Supplementary Card can be issued to family members (over 18 years of age) of the Primay Card Member Please issue a Supplementary Card for my* Spouse Father Mother Son Daughter Brother _ Sister Name* Date of Birth* Gender Male Female Name as desired on Card* eee) | would like to set the refresher limit (spend limit on the Supplementary Credit Card set by the Primary Card Member which is refreshed every at billing cycle) for the Supplementary Credit Card at Rs. {multiples of 000” only) **Instructions - Please enclose the following documents. A self-attested copy of proof of identity (any one of the following)* Passport Voter's ID Driving License PAN Card Photo Ration Card Government ID Card A self-attested copy of proof of residential address (any one of the following)* Passport Voter's ID Latest Electricity Bill Latest Telephone Bill (Mobile/Landline) Ration Card Driving License 1. Voter i/Drivng License willbe accepted as Address proof, if another ID proof from Core document ists provided 2, ID & Address Proof needs tobe ticked out ofthe options provided ‘We confirm thatthe information given is true and correct. We understand thatthe Primary Card Member wil be lable for all the charges incurred wit the Primary Card andthe Supplementary Card, We jointly and severally agree tobe bound bythe Rules and Regulations of use ofthe Credit Card, copy of which we have received ‘and understood In particular, we confirm the usage in svct accordance with the Exchange Contzol Regulations of the Reserve Bank o India. We understand that in ‘the event of fallure todo so, we ae liable for action under the Foreign Exchange Regulation Act, 1973 and may be debarrd fram holding the ICICI Bank Credit Card, ‘ther at the instance of ICICI Bank or the RBI. We authorise ICICI Bank to very information inthis application andto receive and exchange information aboutus with ‘other banks, agencies, companies for marketing and administrative purpose orfor prevention frauds, et Signature of ross the Photograph serine wa X Signature of Primary Card Applicant Date *Please provide separate self attested documents for proof of identity and proof of residential address. Only a valid passport will be accepted in both cases. At any given time, a maximum of up to 2 supplementary cards will be issued to a Primary Card Member including any supplementary cards issued against any other ICICI Bank primary credit card. **As per the provisions of Reserve Bank of India Master Circular (RBI/2003-10/73; DBOD. AML. BC. No. 2/14.01,001/2003-10) on Know Your Customer (KYC) norms dated 01 July 2009, itis mandatory forall banks to update the customer identification documents (including photographs) Please send the completed form along with the documents to : ICICI Bank Limited, Of4 / N1 / CU - 03, 4th Floor, ICICI Bank Towers, Credit Card Operations, Gachibowli Towers, Hyderabad 500032.