PRE-EMPLOYMENT UNDERTAKING & DECLARATION

With reference to your application for a career opportunity at ICICI Bank, you are required to complete a pre-
employment declaration. The declaration and information is collected for the purpose of assessing applicant suitability
for offering an employment opportunity with ICICI Bank. All the fields in this application are mandatory. Applicants are
required to answer all the questions fully and truthfully.
This form will be retained by ICICI Bank.

I affirm that the information furnished in the application below is true and accurate .

PAN Number*:

Full Address with PIN code*:

WhatsApp Number*:

I authorize ICICI Bank to communicate with me on Whatsapp and on phone on the number mentioned above.

PART-1: APPLICANT DETAILS

1. Do you have any immediate blood relatives- (Parents/Siblings/Spouse/Offspring) working or under consideration for
employment at ICICI Bank? If yes, please enter their details.

Relation Name

2. Have you been interviewed by ICICI Bank in the last 1 year? If yes, please enter the details (year /location) in the
text field.

Description

3. Have you been employed by ICICI Bank or by ICICI Group Company? If yes, please enter your ICICI employee ID.

Group Company Emp ID

4. Were/Are there any investigations/disciplinary proceedings or any other processes related to suspected or alleged
misconduct or unsatisfactory performance by your current/former employer(s)?

Details

5. Do you have any criminal case/charges pending against you in the Court of Law/Police station? Was there any
FIR/Investigation/Arrest/Conviction against you in the past for a criminal offence in India or abroad? If Yes, please
mention the details.

Details

6. Are you related to any Director of ICICI Bank/ ICICI Group Company?
 Details

7. Have you cleared CA examination in your first appearance, both groups taken together, in a single sitting?
(Applicable only for Chartered Accountants)

Date of Appearance
Date of CA Examination _ _/_ _/_ _ _ for
_ CA Examination
DD/MM/YYYY

8. Do you have any communicable/ contagious diseases (An infectious disease transmissible by direct contact with an
affected individual)? Do you have any injury/medical condition that can be aggravated by tasks and responsibilities
assigned during the course of employment? If Yes, please give details.

Details

PART-2: DECLARATION & AUTHORIZATION

Declaration:

1. I declare that the information in this declaration and in any other documents completed by me / and or other
statement made by me in support of my application for employment with ICICI Bank and the information
furnished by me with respect to my previous employment/s, compensation and qualification is true and correct
in every detail.
2. I further declare that I am and was never a member of any banned outfits declared by the Government.
3. I understand if an offer for employment with ICICI Bank is made, it has been made basis the information that
I have provided in my application. I am further aware that my appointment and continuation in employment
is subject to successful completion of my graduation/post-graduation, as applicable and submission of
graduation/post-graduation certificates and mark sheets within 3 months from the date of joining.
4. I am aware that in case of any misrepresentation, false statement, discrepancies found out by ICICI Bank at a
later date on any of the above declarations made by me, my candidature as well as subsequent continuation
of employment with ICICI Bank- as the case may be- will be liable to be cancelled/revoked and or terminated,
at any time, without assigning any reason thereof and I shall be bound by any such decision of the Bank. The
same will amount to misconduct and render the applicant liable to disciplinary action including termination of
employment.
5. I understand that any employment by ICICI Bank or its affiliated companies is conditioned upon positive
responses from my references, continued adherence to ICICI Bank policies and procedures, applicable rules
and regulations and job performance satisfactory at all times. I consent to take any pre or post-employment
examinations as may be required by ICICI Bank or its representative, and release ICICI Bank any liability that
may arise from such examination.
6. I understand that my role in ICICI Bank would also be a Sales role and I may be required to travel extensively
as per the requirement of my job/role, as may be needed for the exigencies of the bank. I further understand
that my services in the bank is transferrable in any location across the country as per organization
requirements.

I shall abide by the above terms of my employment

Authorization:
1. I authorize ICICI Bank to procure my credit information from TransUnion CIBIL Ltd. or from any other recognized
credit information company.
2. I agree for pre-employment checks as deemed necessary and hereby authorize ICICI Bank and it agents,
representatives, consultants, service providers to conduct pre-employment checks, including an inquiry into
all the information contained in this application including an inquiry with former employers and officials of
education institutes and self-declared addresses. I further authorize former employers and officials of
education institutes to give information about me and my education credentials and I release them from all
liability for issuing such information.
3. I authorize ICICI Bank to verify disciplinary / compliance related issues from my current/former employers.

Signature of the Applicant

Applicant Name:
Contact No:
Date : _/_/