--------------------------------------------

Save time. For cash deposit use Cash Date /t¡à[¹J:: D D M M Y Y Y Y

Bank Accepter Machine (CAM) / ATM Recyclers Bank
/ Insta Banking Facility/ Î³Ú ¤òàW¡à>¡ú >K \³à PAN of A/c Holder*/"¸àA¡àl¡ü–i¡‹à¹ìA¡¹ š¸à>*
SB/CA/OD/RD/CC Account No./
ë *Ú๠\ì>¸ A¡¸àÅ "¸àA¡ìÎ i¡¹ ë³[Å> (CAM) /&[i¡&³ &Î[¤/[Î&/*[l¡/"à¹[l¡/[Î[Î "¸àA¡àl¡ü–i¡ >}
Deposited in [¹ÎàÒüAáà΢/Òü>Êà ¤¸à[S¡} Îå[¤ à ¤¸¤Ò๠A¡¹ç¡> Loan Account/Credit Card No. /
Source of Funds for NRO Accounts/NRO "¸àA¡àl¡ü–i¡ìι \ì>¸ ó¡àr¡ìι Îèy
Branch / ÅàJàÚ \³à ÒìÚìá:____________________ ëºà> "¸àA¡àl¡ü–i¡/ëyû¡[l¡i¡ A¡àl¢¡ >} :
Dividend/Interest/Warrants/[l¡[®¡ìl¡r¡/Îåƒ/*Ú๸à–i¡Î
Date /t¡à[¹J:: D D M M Y Y Y Y Name of Account Holder /"¸àA¡àl¡ü i¡ à¹ìA¡¹ >à³______________________________________ Rent/Pension/Proceeds of Sale of Assets/®¡àØl¡à/ ëš>Å>/
Deposit Slip / \³à¹ [ÑÚ

Deposit Slip / \³à¹ [ÑÚ

Contact no./ _____________________ Deposited in Branch:/____________________________ š[¹Î´š; [¤yû¡ã¹ A¡à™¢¸[¤[‹ ">¸à>¸,
SB/CA/OD/RD/CC Account No./&Î[¤/[Î&/*[l¡/"à¹[l¡/[Î[Î "¸àA¡àl¡ü–i¡ >} ë™àKàì™àìK¹ >} ÅàJàÚ \³à ÒìÚìá Others, please specify/">åNøÒ A¡ì¹ l¡üìÀJ A¡¹ç¡>______________

Bank / ¤¸àS¡ Branch /ÅàJà Cheque no./ëW¡A¡ >} ` / i¡à@ Ps./ @ Pieces/
Deno/ël¡ì>à ` / i¡à@ Ps./ @
Loan Account/Credit Card No. :ëºà> "¸àA¡àl¡ü–i¡/ëyû¡[l¡i¡ A¡àl¢¡ >} : [ ìÎÎ
2000x

Cheque deposit / ëW¡A¡ \³à

500x

Cash deposit / >K \³à

Name of account holder/ "¸àA¡àl¡ü–i¡‹à¹ìA¡¹ >à³
200x
Particulars / [¤¤¹o `/ i¡à@ Ps./ @ 100x
50x
20x
10x
5x
Rupees in words/i¡à@ A¡=àÚ ëºJà________________________________________________ Others/">¸à>¸
Total/ ë³ài¡ _________________________________________________________________________ only/³ày Total/ ë³ài¡
Rs. in words/ i¡à@ A¡=àÚ ëºJà______________________________________ For office use / "[ó¡ìι ¤¸¤Òàì¹¹ \ì>¸
Signature of
Transaction id./ Officer's sign./ Verifying officer/ depositor/
ëº>ìƒì>¹ "àÒü[l¡ "[ó¡Îàì¹¹ ѬàÛ¡¹ ™àW¡àÒüA¡à¹ã "[ó¡Î๠\³àA¡à¹ã¹ ѬàÛ¡¹
Officer's sign./"[ó¡Îàì¹¹ ѬàÛ¡¹_______________________________________________________
Note: Please use seperate deposit slip for cash deposit , local, outstation & ICICI Bank cheques. ʤ¸ : >Kƒ \³à, Ñ‚à>ãÚ, ¤[ÒÑ‚¢à> &¤} "àÒü[Î"àÒü[Î"àÒü ¤¸àS¡ ëW¡A¡P¡ìºà¹ \ì>¸ ">åNøÒ A¡ì¹ šõ=A¡ [ÑÚ ¤¸¤Ò๠A¡¹ç¡>¡ú
Cheque(s) subject to realisation /ëW¡A¡(γèÒ) "àƒàÚ A¡¹à ÎàìšìÛ¡ For Cash Deposit of Rs. 10 Lacs and above, customer has to furnish source of funds separately. i¡à@10 ºàJ * t¡à¹ ë¤Åã >Kƒ \³à¹ \ì>¸, NøàÒA¡ìA¡ šõ=A¡®¡àì¤ ó¡àr¡ìι Îèy \à>àìt¡ Ò줡ú
Please mention your account no. & name behind the cheque./ ">åNøÒ A¡ì¹ ëW¡ìA¡¹ [šáì> "àš>๠"¸àA¡àl¡ü–i¡ >} &¤} >à³ l¡üìÀJ A¡¹ç¡>ú *For Cash Deposits of Rs. 50,000/-, Please mention your PAN. Please update PAN in your account. *i¡à@ 50,000/- >Kƒ \³à¹ \ì>¸, ">åNøÒ A¡ì¹ "àš>๠š¸à> l¡üìÀJ A¡¹ç¡>¡ú ">åNøÒ A¡ì¹ "àš>๠"¸àA¡àl¡üì–i¡ š¸à> Òàº>àKàƒ A¡¹ç¡>¡ú
Customer should pay/deposit cash at the designated counters only/NàøÒA¡ ëA¡¤º³ày [>[ƒÊ¢ A¡¹à A¡àl¡–üi¡à¹Î³ìèÒ ëš A¡¹ì¤>/>Kƒ \³à ëƒì¤>ú
P.T.O for third party declaration for cash deposit in a/c/"¸àA¡àl¡üì–i¡ >Kƒ \³à ëƒ*Ú๠\ì>¸ tõ¡t¡ãÚšìÛ¡¹ ëQàÈo๠ëÒtå¡ šõË¡à *Âi¡à>
 Miscellaneous Instructions
Declaration for third party cash deposit in savings /current account/ëÎ[®¡}Î / A¡àì¹ i¡ "¸àA¡àl¡üì i¡ tõ¡t¡ãÚ Û¡ >K \³à¹ \ì>¸ ëQàÈoà • Please get your Pass Book updated once in a month.
• Please do not disclose your Account details/Internet Banking
Date/t¡à[¹J :______________________________ User ID and Passwords/ATM Debit Card/Credit Card/Mobile
Banking/Personal Information to any person.
Deposit Amount/\³à¹ "=¢¹à[Å : __________________________________________________ • All changes/stipulations are subject to change from time to
time. Please visit Bank’s website www.icicibank.com for
further information.
Purpose/l¡üì„Ÿ :__________________________________________________________
• For cash deposits exceeding Rs. 50000/- please mention
your PAN or submit signed copy of Form 60.
I confirm that the cash deposit is not towards payment for job offers, claiming lottery winnings /awards /gift /inheritance. /"à[³ [>[ÆW¡t¡ • The customer is obliged to ensure that the details on the
A¡¹[á ë™ >Kƒ \³à W¡àA¡[¹ ëƒ*Úà, ºi¡à¹ã ë\t¡à/šå¹ÑHà¹/l¡üšÒà¹/l¡üv¡¹à[‹A¡à¹ãâ« ƒà[¤ A¡¹à¹ \ì>¸ ëšì³ì–i¡¹ l¡üì„ìŸ >Ú¡ú deposit slip are accurate and match with the details of the
cheque /instructions/cash.
Signature of Depositor/\³àA¡à¹ã¹ ѬàÛ¡¹ :_____________________________________________ • Do not fall prey to false promises, beware of dubious
schemes
Name of Depositor/\³àA¡à¹ã¹ >à³ :_________________________________________________ ">¸à>¸ [>ì ¢Åऺã
• ">åNøÒ A¡ì¹ ³àìÎ &A¡¤à¹ "àš>๠šàΤÒü Òàº>àKàƒ A¡¹à>¡ú
Contact No./ë™àKàì™àìK¹ >} : _______________________________________________________ • ">åNøÒ A¡ì¹ "àš>๠"¸àA¡àl¡üì–i¡¹ [¤¤¹o/Òü–i¡à¹ì>i¡ ¤¸à[S¡} Òül¡ü\๠"àÒü[l¡ &¤}
šàÎ*Úàl¢¡Î/&[i¡&³ ël¡[¤i¡ A¡àl¢¡/ëyû¡[l¡i¡ A¡àl¢¡/ë³à¤àÒüº ¤¸à[S¡}/¤¸[v¡û¡Kt¡ t¡=¸ ëA¡à>* ¤¸[v¡û¡¹
Relationship with A/c Holder/"¸àA¡àl¡ü–i¡‹à¹ìA¡¹ ÎìU δšA¢¡ :_________________________________________ A¡àìá šøA¡àÅ A¡¹ì¤> >à¡ú
• γÑz š[¹¤t¢¡>/Wå¡[v¡û¡ìt¡ Åt¢¡ γÚ-γìÚ š[¹¤t¢¡> ÎàìšÛ¡¡ú "àì¹à t¡ì=¸¹ \ì>¸ ">åNøÒ A¡ì¹
For Bank Use/¤¸àìS¡¹ ¤¸¤Òàì¹¹ \ì>¸ ¤¸àìS¡¹ *ìÚ¤ÎàÒüi¡ www.icicibank.com ëƒJå>¡ú
• i¡à@ 50000/-’¹ "[‹A¡ >Kƒ \³à¹ \ì>¸ ">åNøÒ A¡ì¹ "àš>๠š¸à> l¡üìÀJ A¡¹ç¡> &¤}
Tran ID/ëº>ìƒ> "àÒü[l¡ : ______________________ Signature of BM/DBM/ABM/[¤&³/[l¡[¤&³/&[¤&³ &¹ ѬàÛ¡¹ : ____________________________ ѬàÛ¡[¹t¡ ó¡³¢ 60’¹ A¡[š ƒà[Jº A¡¹ç¡>¡ú
• \³à¹ [ÑÃìš¹ *š¹ ëW¡A¡/[>샢Åऺã/>K샹 [¤¤¹ìo¹ ÎìU Î[k¡A¡ * [³º =àA¡à [¤¤¹o
Name of BM/DBM/ABM/[¤&³/[l¡[¤&³/&[¤&³’¹ >à³ _________________________________________________ [>[ÆW¡t¡ A¡¹ìt¡ NøàÒA¡ ¤à‹¸¡ú
• [³=¸à šø[t¡Åøç¡[t¡¹ [ÅA¡à¹ Òì¤> >à, Îì–ƒÒ\>A¡ ÑHã³Î ë=ìA¡ Îऋà>¡