X

ICICI Custorner ID 5 7 8 72/02 A

O
Bank
FHELDSWITHISTAR)ARE MANDATORY Account&1
nbgr 4o509 50 oD
Please fill in all the detaiis in CAPITAL
LETTERS and use BLACK INK onty. Plsns TCK (/) nyanprintr gdin ta
TYPEOF ACCOUNT
CukRENT ACCOUNT EXCHANGE EARNER'SFOREIGN CURRENCY ACCUNT (EEFC) PMCIAL SAVINGAOLOATr
IKIT/NON-IKIT NONIKIT
PRODUCT DETAILS *Product Name: SBh 1
MAe QTP Others Value
Branch:_ pdle Branch Code:
te aplicsBls sechedula of chinrgos

APPLICANT DETAILS
Account Title/Name:
(hAsximum 40 characters) T MD NIC Kn M
*Date of
Incorporation/
Date of Birth: Existing
Alc. No. Marf
Joint Applicant
(Ony Primary Applicat
is tndividu
tmporter/Exporter Code Number (if any)
cOMMUNICATION ADDRE8S
Particulars: 907
RAMAE HAN DRÐ PURM 7 REETT
City
State: MIL NAD U 622 oo
Telephone Mobíle
Fax:
E-rnail ID:2 ma (
REGISTERED ADDAESS For Entitiesj/ RESIDENCE ADDHESS (For
Same as communication address. Yes No
Proprietor/individual)
(if no, fillin the details belov)
*Particulars:

City
State
Telephone: Mobile
Fax:
E-mail ID

PAN OF APPLICANT:
FORM 49A FORM 60/61
CONSTITUTION
MbviDUAL sOLE PROPRIETOR HUF PARTNERSHIP PUBLICLTD.
PRIVATE LTD. SECTION 25 STATUTORY BODY/ GOVERNMENT BODY
TRUSTIASS0/sOC./CLUBs
OTHERS
Onlyfor Trust/Asco/Soc./Clubs/Sec. 25Co. Vae sarone cd the opaione NGO FOUNDATION
Tobefilledin for Exchange Earners Foreign Curreney Account (EEFC a0count)
STATUS Unitin SEZ Unit in STP Unit in EHTP 100% EOU Unitin DTA for supplyto SEZ Unit in EPz
Individual Professional Ordinary Resident atus Holder Others

CURRENCYsb For other Currencies,

EURO GBPOTHERS: JPY
Check with Bank Official
&MSE Cobd isa voluntaryCode reflecting the hanks poaiivscormmitment to is Microand SmallEnterprise (MSE] custormere. This Code is not
ontly e Chartor of Rights ot h e ME DUT os0 enshrines his obligations is-B-V1S his benk, For more detuile pleusa visit www.icicibarnk.com
MAB Monthly Average Balance, OTP-Ouarterty Thsoughpn
Please fillin adsitional personel details in case of individusl on Pagu na. 6 X
X
DOCUMENTs REQUIRED FOR OPENING cURRENT ACcoUNTS (NON-INDIVIDUALS)
SOLE PROPRIETOR
One Entily Proof Irom
Table A
Second Entity Proof
from Table A/ A2/C
Address Proof if
different
from First Entity Proof
Proprietor ship Letter
ID Proof of
Proprietor
If New Firm, Address
Proof of the Proprietor's
residence
PAN Card in the Name
of the Proprietor or Form
49A
A
PARTNERSHIP PUBLIC/ PRIVATE LTD LIMITED LIABILITY HUF
PARTNERSHIP
Partnership Registration Certificate of Incorporation Limited Liability PAN Card in
Certiticate, if Registerecd Memorandum of Association & Partnership Registration the name of
Entity Proof from Table A Articles of Association Certificate. Hindu
Partnership Deecd Certificate of Commencement of Limited Liability Undivided
Partnership Letter Business (for Public Ltd only) Partnership Registered Family
PAN Card of the Firm or Communication Address Proof of Address Proof if different Hindu
Form 49A Company. from the address on the Undivided
Registration Certificate Family Letter
Acldress Proof in the Registered Address Proof of the
Firm's Name from Table C Company if the address is different Communication Address ID Proof of
if the address is different from the Communication Address. Proof if not given on the Karta
or not given in the Entity Board Resolution Registration Certificate Address Proof
Documeint ID Proof of Authorised Signatory Limited Liability of Karta or
D and Address Proof ofProof of Appointment of the Current Partnership Agreement Hindu
all partners Limited Liability Undivided
Director if it is not in the First List of
Directors Partnership Letter Family
PAN Card of the Company or Form ID Proof of Authorised No Objection
49A Signatories Certificate if
PAN of Limited Liability credit facility is
Partnership or Form 49A being availed of
from any bank.

NOTES Any other ldentity, Address, Entity, Document can be accepted/ submitted subject to the Bank's satisfaction.
N o Objection Certificate if availing credit facility has been availed of from any bank.
An initial funding cheque is required for opening accounts of Sole Proprietorship, Hindu Undivided Family, Partnership Firm.
Document should be valid as on the date of submission.
Driving License or Voter Identity Card can be used both as ldentity and Address proof of Partners.
PANis Mandatory for opening
more than
one account. Form 49 A)is
not acceptable.

ENTITY PROOF ENTITY PROOF ADDRESS PROOF ID/ADDRESS PROOF OF INDIVIDUAL

(FIRM NAME) (FIRM NAME) (FIRM NAME)
TABLE A TABLE.A2 TABLE C TABLE 8

Trade License /Value
Added Tax /Tax
Deduction Account
Number Certificate
Allotment Letter
Sales Tax / Service
Tax/Tax identification
Number.
|.PAN/PAN Intimation
|Letter in the name of
the Firm
Income Tax
Assessment Order in
the name ofthe Firmn
Certified Security
Exchange Board ofIndia
/ Insurance Regulatory
and Development
Authority of India
Registration Certificate.
Certified Chartered
Accountant / Company
Secretary / Institute of
Cost &Works
Accountants of India.
Shops&
Establishments
Certificate
Tax Deduction at
Source Certificate
issued by banks/ public
sector unit.
Less than 3-month-old
| Gram Panchayat
Certificate
Factory Registration
Certificate/ Small-scale
Industries Certificate
Property Tax
|Receipts
Importer - Exporter
Code with PAN
Any Other Document
issued by Local/State/
&Central Government
A O
Certified Chartered Bank Statement of 3
Accountant's Certificate Months (scheduled
Bank A/c Statement of bank) that are less than
a Scheduled 4 months old
Commercial Bank and Registered
Cheque from the aame Unregistered Leave
account. License Agreement with
Statement from Co- Utility Bill in the name of
operative Bank in rural the landlord
location
Electricity/ Telephone
Sales Tax Return withBilless than 3 months
old
the Firm's Name
Income Tax Return Certificate lssued by a
with the Firm's Name Muncipal Corporation
Property Tax Bill,
Water Tax less than 6
months old
True Copy of Gas
Connection Book with
receipt less than 3
months old
Letter from existing
Banker (Schedule Bank)
Form 18 with ROC
receipt
A) List of Proof which can be accepted for Identity Proof
Pan Cardissued by Income Tax Dept/ UTITSL NSDL
Voter ID Card
Bar Council/IMA/Sr. Citizen Card
PIO Booklet for Returning NRIS with details of customer's
photograph & validity mentioned
B} List of Proof which can be accepted for Address Proof
Utility Bills (Electricity Bill, Telephone Bill) not older than 3
months
Statement of Accounts of 3 Months/ Passbook with account
opening cheque of a Scheduled Commercial Bank
Consumer Gas Connection Card along with the receipt of gas
Supply not older than 3 months
Registerad Leave & Licence Agreement along with utility bill
not older than 3 months in the name of the landlord
Post Office Savings Passbook with account opening cheque
Latest Premium Renewal Receipt from any Life Insurance
Company
Domicile Certificate with Communication Address&
Photograph issued by a District Magistrate or an officer of equal
rank
Certificate by Village Extension Oficer/Village Head or Equal
Or Higher Ranking Officer
Ration Card containing Signature & Stamp of An Official
Authority
C) List of Proof which can be accepted for both ldentity as well
as Address Proof
Valid Passport with photo and signature
Driving License
Printed Ration Card with photo/AP household card
Domicile Certificate issued by Sikkim Govt.
ID Card with Photograph issued by Govt of Jammu and Kashmir
Arms Licence issued by State/central Govt of India Authorities
Freedom Fighter Pass issued by Ministry of Home Affairs, Govt
of India with Photo
Bank Passbook with Photo and Account Opening Cheque
issued by Nationalized Bank
Photo Social Security Card (smart Card) issued by
State/Central Govt. or Union Territories
NotesForSoleProprietor/ HUF: Voter 1D/ (DL) Driving Licensecan
be used as Address Proof if another document is provided as ID
x
X
"w ue msormh A

O
Bar Code Number 93 &

CustomerID

58 78g o 87
*Account Number

(To be filled in by a Bank Official)

PERSONAL DETAILS(Tobeflled in by applicantwhoseconstitution typeisIndividual)

Account Name:- MANZCKPA
Fathers Name:
SRS AT HEP PRDB
Mother's Maiden Name:

Nationality,
SARA N4
If other than Indian Gender:Male Female

Marital Status: Sngle Married UD

EXpiry date
Identity ProofA AD H BRCARD -
(Wharoveropplicable)

Address Proof DH ADR ARD

OWNERSHP AND CONTROLSTRUCTUREINFORMATION SHEET
Account Title / Name ANI CCAM
***** ********** **

1. Name (Mr./Mrs./Ms./Dr.)*
Applicabte for Joint Account holders,
Authorised Signataries, Partners, Directors.
T MANECEn M
Trustees, Grantors,Setdors and Beneficiaries
ofTrusts)

Date of Birth XNationality: W DAO

Type of ldentity Proof:
AADHPA R CARD
NumberA R X AX X x XAX
Residemtial
SY Address 0 7 R MAc,h A DR P Rn M
STRE T
CityP D rc TT AT
State: M I NADU PIN
6290o
Designation

A X
5
 Customer Relationship Form A
O ICICIBank (For Individual, Non-individual and TASC customer)
e a d , undurstood and hereby agree to thu terms stated in this Application Form as
*DECLARATION
T n n 0ovaning tho (Curront Account /EEFC occount/Spocinl Snvinai
&
arious facilitius/services such as mobile banking, corporale into 09
uvalo)igrom
indur nk CUrrnt
c o u n t and as displayed on www.icicibank.com and agr0 id a tha same. 1We undorstand tat thio sold torma ora Gubjoct to ravision lino to tima and Iwo iGcount/EEFC account/Spacial
ugre lo kuep oursolvos
O Such changes and be bound by the terns às oro in updatod
We confirm tha 1orcu Bont diall the portnora of 1ho firm/all mombers of tha HuF IManaging omag,
nat he authorsed signatoriEs upp
03
siect ary applicotion without providin0 any reas0n. /Ve gren andnoerbono nat
aro autodu
DODk L0,
o operitu to
llu uccount. 1Wo agrou and
rophs, and will not raturn the ame io me/ug.
iL rO30rv0a tho
igt rotaln tho
Applicatlon, and
UWe further agree that anyfols e/misleading information givan by mc/us, or supprossion of any matorial fuct vill rondor mv/our account liobtu for closure and further action.
Wa also hereby agrce to indemnify ICICI Bank and their successors or a6signees " any oi ina roprOBantaliong dnd declur ations mada har cundar by me/us is incorrnct, false or

particulars.
We declare, confirm,
tai agree
the particulars and information iven in the Application form (and oll documents roterrod or providad thorowith) aro truo, corroct, complato and upto datu in all rospecis ond I/wu have not withholei
y inform dertake to provido any further intormntion hat Bank Ltd./ts Aliotgs may roqiro, b that iw0 havo had no Insolvunay initiatod agaln
been udjudicated insolvent, c) that l e have not at uny time delaulled undr By 1oan takon hy me/us trom any other bnk/institution, or been in non-complianco
rules/regulations/guidolinos in force from timo to timo, as framed bvthe Reserve8ankof India, di) that wo have raod an agroe to tha tharyes applicablo to Current account/EErC account/SpescintSaVino
nceountondalotherfaciliies to bo ovatled by me/us and heroby agroe to hoar the chargosas revisedfeom timo to timu by ICICI Bank atits nolediseretion.
1Wa have read and understood the facilities availahle undor lCICIEankCurrentActounttru accoun/SpecialSivingaccountas lrsled onthe lCiC BankWebsite.IWe have nlno (gone through tho schacduilo
of charges and understand that to be eligible for the concossions, w e have to matntoin tho minimum Monthiy averane balance (MAB| or the Quartoriy through put(aTP), o» th0 case muy bo, os indicatedin th
Schedule of Charges and agreed upon by me/us on a Monthly/ duorterly basi3and in he avcniwo toilto do Go, w o shou bo ioblo to pay a f0o ovory Month/Quarteras indicatucd in tho schodulu of charges,
We also understand that continuaion of 1he account is at lciCl Bons ol0dsCrOOn n d in caso CCI Bank Is dis salistiad with tlhu conduct ol tho accout, ICICI Barnk has tho right to closo the accou atttor
giving meus 15 days notice or withdrav the concessions in all or any service chargesgranted to me/us and/or chargo ICICI Bonk't applicablo ratas for sorvico0avaitoc by ma/us.
1/We hereby declare thet in case of being prolessional(s) by occupolion, ihe said accouni wil bo uged oxcluclvoly for our own trantactions and not on bohalf of my/our clionts. "(not applicable for requlated
and superVIsed indrviduals and entities)
We hereby further confirm having read and understood the opplicahle rules/regulatons/instruction/guidolinos ns fromod by tho Rosorvo Bonk of India, including tho FEMA rogulations 2000 jovarningg EEFC
Accounts, and the Foreign Exchange Management Act, 1999, in force itrom inie 1o Time and anree to ahide by and to bo bound by nll such applicable Low, rules, regulations and çuidolinos in forco from time to

ma
We hercby authorize IcIcI Bank to exchange, share or part with al tho Intormation/dala provicdod liorein including personal and business informalion witl firnancial institutions/credit bureaus/agencies/
statutory bodies/other such persons, in order to facintate the a n 1O compywith t s obigations undor vorious opplicoblo laws, rogulotions, and otandards. I/ Wo slhall not hold lcici Bank Ltd. or its
agents/representatives liable for using /sharing information provided herein for the said purpose,
We shall keep ICICI bank informed at all times, regarding any changes/altarlion in my/our communication acddress ond outhorlzo tha Bonk to updota ony such chongo/altaration in my/our communication
address that the Bank muy be informed of by me and/or is brought to the notice ol tha Bank arnd hereby Duthorizo lCICI bank to contact mo/us on such chang»cd/altoredd addrass. /Wa shall he solely responsibl
to ensure that lCICi bank has been informed of the corrOctaddress TOrcommunication.iWe agroo to indumnify IcIci bank against any fraud or any loss of dasneged suffuracd by tCtICi Bank due to mýlour
providingof amy incoTect communication address end /or tailure on my/our pan to communicale the chonge/oltorbtlon in my/our communication acddrosn.

We declare that l/we do not enjoy any credit facility with any bank.

We enjoy the following credit facilties with other banks at present

We declare that Iwe are not listed on any Stock Exchange.

We declare that l/we are listed on the following Stock Exchange(s)

iWe declare that Iwe do not have any accounts with ICIci bank in my/same entity's namo.

IWe declare that iMwe have applied for the current accounts with ICICI Bank in my/same entity's name with the following AOF numbers.

We declare that l/we already hold the following current accounts with ICICI Bank in my/same entity's name with the following account numbers.
Account Numbers/AOF Numbers ( use separate sheetfor having more than 5 accounts/ applied for more than 5 accounts with AOF numbers)

We hereby authorize ICICI Bank to exchange, share or part with all theinformation/data provided herein including personal and business information with ICICi group companies / other
institutions/ such other persons as may be necessary/ required for the purpose of, including but not limited to, marketing, cross selling of various products and services etc, to me/us, use
or process the aforesaid information/ data by such persons/s, or furnishing ofthe processed information/ data/ products thereof to other Banks/ Institutions / other persons as may be
necessary, and Vwe shallnothold ICICI Bankliable inconnection with theuse ofsuch information orotherwise.Yes No
The Applicart/is has/ have no objection to ICICI Bank Limited, its group companies, agents/ representatives to provide me / us information on various products, ofers and services
provided by ICICI Bank/ its groupcompanies/other entities through any mode (including without limitation through telephone calls / SMS/ E-mail) and authorize ICICl Bank / its group
compenies/ts agets/fts representatives for the above purpose. Yes No

Date For Authorised Signatory

(Rubber seal of company required)

FOR ICICI BANK USE ONLY -KYC-ADDENDUM- TO BE FLLED IN BY THE BANK OFFICIAL
Name &Signature of Bank Official who have mat the authorised signatory in person at his/her officelothers and confirming that
he/she hasverified the copies of the documents (as applicablo) againstoriginal as produced by the applicant and in whose presence form has
been signed by authorised signatory. (Please stamp the photograph with the ICICI Bank stamp.)
Name MANICAAm
Employee IDXXXXKX Date Signatur.

Constitution Code E Sector Code* BANML Sub Sgctor Code NL

Occupation Type*. Customer Type
Industry Type*
KYC Report enclosed Exemptedfrom TDS Nomination form enclosed
Company Rating
To be filled in by Bank Official
Lead Generator Code KAX XX LeadUpdator Code A X X
Mappod SM
Lead Fulfiller Code

Acquisition Channel Code: s A1 SFA Code

Verified by: Anywhere Cash Deposit facility to be activated 7Yes No

Bank Official's Name:

Employee's1D: X x XXAX Mobile: sO0080O] Signature. codes to be WTitten.

: Business Groups>WBG> Support Group>General Banking Group>
GBO> Currontaccount> list of codes) and eppropriate
Code numbers to be viewed from the Intranet (address
K
A
X
*
PROFILE OF AUTHORISED" A
SIGNATORY(IES) TO ACCESS AND OPERATE THE
Tease use another Annexure if the number of authorised signatories are more than 4)
ACCOUNT (Please sign in Black Ink only)
Corporate Corporate
Authorised
Photograph Signature Signatory
Debit nternet Phone
-RIT
Card Access Banking Banking
ISSUeu Pmeoseretertotivo Annerure PeietelertotheAnnerure)Ploas retor to theAnnexure)
V

Email D
Paste a recent
passport
size photograph
here
Mr./Mrs./Ms./Dr.
(35 mm x 35 mm) Mobile
Designation

nmail ID
Paste a recent
passport
size photograph
here
E Mr./Mrs./Ms./Dr.
(35 mm x 35 mm) Mobile
Designation

Email D
Paste a recent
passport
size photograph
here
Mr./Mrs./Ms./Dr.
(35 mm x 35 mm) Mobile
Designation

Email ID
Paste a recent
passport
size photograph
here
Mr./Mrs./Ms./Dr.
(35 mm x 35 mm) Mobile
Designation
PLEASE SPECIFY THE MODE OF OPERATION
Letter!Proprietorship Letter
Pleaseprovide Board Resolution/Partnership
As per Board Resolution Others as applicatble.
Singly/Severally Jointly
PROFILE INFORMATION OF APPLICANT(Please capture Joint Applicant's Profile inseparate AOF)
Graduate Post Graduate Professional
UnderGraduate
1 Education (For Individual/ Soie Proprietor Appliconts Only)
Retired/'Housewife Student
Self Employed Salaried

2 Occupation Others
Lawyer Architect Consultant Engineer
Doctor CA/CS
3 Type of Profession-
(f Self employed end if
Prafessional)
Others Retailing
Manufacturing Agriculture Related
Services Trading
4 Nature of Business Stock Broker Real Estate Othars
(1f Self employed and if in Business Multl-Lovel Marketing
3to <5Years 5to< 10Years 10Years
1 to<3Years
5 Number of Years in Business year
10 Lacto <25 Lac 25Lacto<1 Cr 1Crto<100Cr 210Cr
10 Lac
6 GrossAnnual Income lin ) 2100 Cr
< 40 Lac 40Lac to <5Cr 5Crto<25Cr 25 Crto 100 Cr
7 AnnualSales Turnover (in
cODE:
liko fixoddoposits)
8 Typeofindustry - -

lor transactlonal accounts end

not
for tinme depoalt
accounts

in a Month in Rupees (Required only 21Cr

9 Expected Value of Transaction 1 Lacto <10 Lac 10 Lac to<25 Lac 26Lacto1Cr
1 Lac
a. Total Cash Deposit (in
In Base Location In Non Base Location (%
b.Percentage of TotalCash Deposits 1 Lacto <10 Lac 10 Lac to<25Lac 25 Lac to<1Cr 21Cr
c.Total Cash Withdrawals tin 1 Lac In Non Base Location. (o
In Base Location
d.Percentage of TotalCash Withdrawals 25 Lac to <1Cr 21r
10 Lac to <25 Lac
1 Lacto <10 Lac
e. Total Non Cash Deposits in the A/c.fin ) <1 Lac 10 Lac to <25 Lac 25 Lacto<1Cr 21Cr
1 Lacto <10 Lac
1. Total Non Cash Withdrawals in the ANc. Un R) 1 Lac
25 Lac to <1Cr 21Cr
I 0 Lac 10 Lacto<25 Lac
9.Foreign Inward Remittances(in ) NA

<10 Lac
10 Lacto <25 Lac
25 Lacto <1Cr 21Cr O
h. Foreign Outward Remittances tin Fi NA
& Donatlons/Grants Others
Business Income
10 Source of Funds and identity proo. X
to access the accounts require to submit their recenl photographs
FAIl Signatorics authorized

2

DocUMENTS REQUIRED FOR OPENING CURRENT ACCoUNTS (NON-NDIVIDUALS)
SOLE PROPRIETOR
One Entity
Table
Proof from
Second Entity Proof
from Table A/ A2 /C
Address Proof if different
from First Entity Proof
Proprietorship Letter
ID
Proof of Proprietor
If New Firm, Address
Proof of the Proprietor's
residence
PAN Card in the Name
of the Proprietor or FormID and Address Proof of
49A
PARTNERSHIP
Partnership Registration
Certilicate, if Registered
Entity Prooffrom Table A Articles of Association
Partnership Deed
Partnership Letter
PAN Card of the Firm or
Form 49A
Address Proof in the
Firm's Name from Table C
if the address is difforent
or not given in the Entity
Document
all partners
A
PUBLIC/ PRIVATE LTD LIMITED LIABILITY HUF
PARTNERSHIP
Certificate of Incorporation Limited Liability PAN Card in
Memorandum of Association & Partnership Registration the name of
Certificate. Hindu
Certificate of Commencement of Limited Liability Undivided
Business (for Public Ltd only) Partnership Registered Family
Conmunication Acddress Proof of Address Proof if different Hindu
from tho address on the Undivicled
Company Registration Certificate Family Letter
Registered Address Proof of the
Companyif the address is different Communication Address ID Proof of
from the Communication Address . Proof if not given on the Karta
Board Resolution Registration Certificate Address Proof
ID Proof of Authorised Signatory Limited Liability of Karta or
Hindu
Proof of Appointment of the Current Partnership Agreement
Undivided
Director if it is not in the First List of Limited Liability
Directors Partnership Letter Family
PAN Card of the Company or Form ID Proof of Authorised No Objection
49A Signatories Certificate if
PAN ofLimited Liability credit facility is
Partnership or Form 49A being availed of
from any bank.

NOTES Any other ldentity, Address, Entity, Document can be accepted/ submitted subject to the Bank's satisfaction.
No ObjectionCertificate if availing credit facility has been availed of from any bank.
Aninitialfunding chequeis requiredforopening accounts of Sole Proprietorship, Hindu Undivided Family, Partnership Firm.
Document should be valid as on the date of submission.
Driving License or Voter ldentity Card can be used both as ldentity and Address proof of Partners.
PAN is Mandatory
for opening more than one account. Form 49(A) is not
acceptable.

ENTITY PROOF ENTITY PROOF ADDRESS PROOF ID/ADDRESS PROOF OF INDIVIDUAL

FIRM NAME)
TABLE A
Trade License /ValueCertified Chartered
|Added Tax /Tax
Deduction Account
Number Certificate/
Allotment Letter
Sales Tax / Service
Tax/Tax ldentification
| Number.
PAN/PAN Intimation
Letter in the name of
the Firm
Income Tax
Assessment Order in
the name of the Fimn
Certified Security
Exchange Board of India
/ Insurance Regulatory
and Development
Authority of India
Registration Certificate.
Certified Chartered
Accountant/ Company
Secretary/ Institute of
Cost &Works
|Accountants of India,
Shops &
Establishments
Certificate
Tax Deduction at
Source Certificate
issued by banks / public
sector unit
Less than 3-month-old
Gram Panchayat
Certificate
Factory Registration
Certificate / Small-scale
|Industries Certificate
Property Tax
Receipts
Importer- Exporter
Code with PAN
Any Other Document
issued by Local/ State/
Central Government
A
(FIRM NAME) (FIRM NAME)
TABLE A2 TARLE C
Bank Statement of 3
Accountant's Certificate Months (scheduled
Bank A/c Statement of bank) that are less than
a Scheduled 4 months old
Commercial Bank and
Registered/
Cheque from the same Unregistered Leave &
account. License Agreement with
Statement from Co- Utility Bill in the name of
operative Bank in rural
the landlord
location
Electricity/ Telephone
Sales Tax Return with Bill less than 3.months
the Firm's Name old
Income Tax Return Certificate lssued by a
with the Firm's Name Muncipal Corporation
Property Tax Bill,
Water Tax less than 6
months old
True Copy of Gas
Connection Book with
receipt less than 3
months old
Letter from existing
Banker (Schedule Bank)
Form 18 with ROC
receipt
Domicile Certificate issued by Sikkim Govt.
Freedom Fighter Pass issued by Ministry of Home Affairs, Govt
Photo Social Security Card (smart Card) issued by
TABLE B
A) List of Proof which can be accepted for ldentity Proof
Pan Card issuecd by Income Tax Dept UTITSL/ NSDL
Voter ID Card
Bar Council/IMA/Sr. Citizen Card
PIO Booklet for Returning NRIS with details of customer's
photograph & validity mentioned
B) List of Proof which can be accepted for Address Proof
Utiity Bills (Electricity Bil, Telephone Bill) not olderthan 3
months
Statement of Accounts of 3 Months/ Passbook with account
opening cheque of a Scheduled Commercial Bank
Consumer Gas Connection Card along with the receipt of gas
supply not older than 3 months
Registered Leave & Licence Agreement along with utility bill
not older than 3 months in the name of the landlord
Post Office Savings Passbook with account opening cheque
Latest Premium Renewal Receipt from any Life Insurance
Company
Domicile Certificate with Communication Address&
Photograph issued by a District Magistrate or an officer of equal
rank
.Certificate by Village Extension Officer/Village Head or Equal
Or Higher Ranking Officer
Ration Card containing Signature & Stamp of An Official
Authority
C) List of Proof which can be accepted for both ldentity as well
as Address Proof
Valid Passportwith photo and signature
Driving License
Printed Ration Cerd with photo/AP household card
ID Card with Photograph issued by Govt of Jammu and Kashmir
Arms Licence issued by State/central Govt of India Authorities
of India with Photo
Bank Passbook with Photo and Account Opening Cheque
issued by Nationalized Bank
State/Central Govt. or Union Territories
Notes For Sole Proprietor/ HUF: Voter 1D/ (DL} Driving License can
be used as Address Proof if another document is provided as ID
x
X
A

2. Narme(Mr./Mrs./Ms./Dr.)*
(Applicable for Joint Accountholders,
Authorised Signatorios, Partners, Dirgctors.
rustees, Grantors, Settlors and Beneticiaries
Trusts)

Date of Birth: * Nationality:

Type of ldentity Proof:

Identity Proof
Number
Residential Address

City
State IN
* Designation:

3. Name (Mr/Mrs./Ms./Dr.)*
(Applicable for JointAccountholders,
Authorised Signatories, Partners, Directors.
Trustees, Grantors, Settlors and Beneficiaries
ofTrusts

Date of Birth: * Nationality:

Type of ldentity Proof:

ldentity Proof
Number
Residential Address

City:
State:
PIN N
Designation:
4. Name (Mr./Mrs./Ms./Dr.)*
Applicablefor Joint Account holders,
Authoris Signatories, Partners, Directors.
Trustees, Grantors, Settlors and Beneficiaries -

of Trusts)

Date of Birth:
***
Nationality:
Type of ldentity Proof
Identity Proof
Number
Residential Address r- *-*

N
City:
TY State:
PiN N
.

*Designation:

For1CICI Bank use only: Name & Signature of Bank Official

Name

Employee ID
Date
Signature
A
X
 A
X CORPORATE INTERNET BANKING (CIB)- TRANSACTION ACCESS (Please refer to the Annexure for details
l-Kit
and customer who is not applying for
Applicable only for authorised signatories

OExisting CIB Corporate ID, if anyl ---

Options/User Name

General Banking

1.Openingof FD, 2. Stop Payment and 3. Roquest for Cheque Book [Documontation Roquirnd- None
Funds Transfer to Own Account &
Salary Payments (Within ICICI Benk) A Authorisalion Letter
Salaryupload) (Documontatlon Required-
nSTer- Own Account 2. Bulk Upload- Transferto any ICICI Bank accounts (e.g.
Inward Funds Transfer
Within ICICI Bank)
linked accounts/Documontation
Reguired- Authorisation Letler,
Power of
Artomevan
Afrtormey
wnAccoUnt fe.g. Dealer collectlon) 2. Bulk upload Debiting externally
andIndemnity Letter as perBank's format tor debiting an oxternalaccoum
Funds Transfer to Third Party
Within IGICI Bank)
Requirod-AAuthorisation Letter& Mandate
2. Bulk Upload-Crediting extornally linkad accounts/Documontatlon
Letteren aACCOunt le.g. Vendor payment)
Letter asperBank'sformat for crediting an externaloccount)
Funds Transfer to Third Party
(Outside lICICI Bank)
Bank Account Holder (NEFT)/Documentation
Roquired-yAuthorisation Letter
. eal me Gross Settlement (RTGS) 2. Inter Bank Transfer-Fund Transfer to Non- ICICI
Bulk Transfer

1.Bulkupload: nterBankTransfer (NEFT)/Documentation Required- Authorisation Letter, Lotter of Linking asperBank's format

Bil Payment/Tax Payment

1.8ill Payment (Including Tax Payrmen) Documentation Required- Authorisation Lettorj

Minimum Limit ()

Maximum Limit )

1.
ARproversName- Pleasemaintain user order
forapproval fapprover should be a user in
CiB with the same access option)
Please give approvers name only. 2.
do not sigr

Please Note: a Authorisation Letter-Board Resolution/Partnership Letter/Proprietorship Letter as applicable.

ALERTS
ON MOBILE (Chargeable Servicel/ E-MAIL IFree Service)
We would like to receive the account information through
+91
SMS on the Mobile

OR Email ID
************

STATEMENT VIA E-MAIL (Free Servicel/FAX (Chargeable Service

Email D Fax (lf you opt for Fax please give country and state code eg. 912256661430)
1

&-mail Statement will bo coa to the above IOs as per tho froquancy anoC0 LinKOa F dolois WIl bo inaludod in the E-nmol Glalomonts only onca a month and shal bo sont to tho first E-mal ID givan abova.
| E-mail is free but lax is a chargeable sorvice (Pleese relor lo tne s o , aRIrnum nvo o-maulda can uo ropistred tor Accoun Bttemont Via E-mal and the frequency is same for all users.

Frequency Daily Weekly Forthnightly Monthly

CHEQUEBoOK REQUIRED YES NO
NOMINATION (Onlyforlndividuals Sole Proprietors:
Required (Pleasefill in DA1 form) Not required (Please signbelowdeclaration)
have been explained about the benefit of the nomination facility.
However, I would like to inform you that I do not wish to provide nomination for account.

A X