Page 1 of 2 M-24384197-17747

072013/24384197-17747/1-2/RESGB/03-02
Your Base Branch : ICICI BANK LIMITED
BRANCH, ICICI BANK LTD., E-1002 C. R. PARK
110019
MR.OM SHIV TIWARI
CHHATA,CHHATA,CHHATA
BALLIA : Visit www.icicibank.com
UTTAR PRADESH - INDIA - 277210 Å Dial your Bank 1800 1080

Never share your OTP, URN, CVV or passwords with anyone, even if the person claims to be a Bank employee.

STATEMENT SUMMARY for Customer ID : XXXXX3391 as on February 28, 2023

ACCOUNT DETAILS - INR

ACCOUNT TYPE ACCOUNT BALANCE (I) FIXED DEPOSITS (LINKED) BAL. (II) TOTAL BALANCE (I+II) NOMINATION

Savings A/c XXXXXXXX1503 0.00 0.00 0.00 Registered

TOTAL 0.00 0.00 0.00

Statement of Transactions in Savings Account XXXXXXXX1503 in INR for the period February 01, 2023 - February 28, 2023

DATE MODE PARTICULARS DEPOSITS WITHDRAWALS BALANCE

01-02-2023 B/F 0.00

UPI/340961698294/Payment from Ph/rohittiwari9015/HDFC
13-02-2023 4.00 4.00
BANK LTD/YBLe9aca90733bd44a18f64ced265d8170b
13-02-2023 VSI/GOOGLE PLAY/202302122211/304316426996/ 2.00 2.00
UPI/341020764964/Payment from Ph/tiwari.namonara/Paytm
13-02-2023 150.00 152.00
Payments /YBL5bb54d05320348feb019fc99ad5e593a
UPI/304440069585/Payment from
13-02-2023 Ph/9289099140@ybl/INDUSIND 150.00 2.00
BANK/YBL8db315c243c649a2998f62ba9672731d/
UPI/341292938339/Payment from Ph/tiwari.namonara/Paytm
15-02-2023 2,500.00 2,502.00
Payments /YBL0bfe1a51a471437f8199660bc21cb0fc
UPI/304638441361/Payment from Ph/omshivtiwari864/India
15-02-2023 2,500.00 2.00
Post Paym/YBLfeec2af252ae45088c35c2f0c08c3771
UPI/341300436227/Payment from Ph/7408284476@ybl/Paytm
16-02-2023 100.00 102.00
Payments /YBLe8fe874e7b8947ae99a6d01d687344d9
UPI/304758068502/Payment from Ph/omshivtiwari864/India
16-02-2023 100.00 2.00
Post Paym/YBL6cfb28b340dd4576aa870dc6e325d6b2
UPI/304822057978/Payment from Ph/patelshivam7273/Bank
17-02-2023 500.00 502.00
of Baroda/YBLd935044f89524e0b9d5c3fd4f629e230
UPI/341488784602/Payment from Ph/9987757743@ybl/Bank
17-02-2023 500.00 2.00
of Baroda/YBL0723b9826d634d00b58bdd5f0a6a208b/
UPI/341507987954/Payment from Ph/7408284476@ybl/Paytm
18-02-2023 100.00 102.00
Payments /YBL9f4b7c1b862041909f91523ba6a8ff16
UPI/304986948855/Payment from
18-02-2023 Ph/paytmqr28100505/Paytm Payments 20.00 82.00
/YBLa9a2e9a05b7a482283f27cdb8cff2459
UPI/304913474503/NA/9682226272@payt/India Post
18-02-2023 10.00 92.00
Paym/PTMe3a9b5b34c45468c9d479062919a25f1
UPI/304918899331/Payment from
18-02-2023 Ph/9289099140@ybl/INDUSIND 90.00 2.00
BANK/YBL2a233d0b93db407f873d491bfc929575/
UPI/341751875224/Payment from Ph/tiwari.namonara/Paytm
20-02-2023 24.00 26.00
Payments /YBL9554f4480e914ec4aa20f1531cf25eed
UPI/305101060111/Payment from
20-02-2023 Ph/paytmqr28100505/Paytm Payments 20.00 6.00
/YBL8fe6efc3d9e04eef8a1e31c6fc1d87ce
UPI/341760752662/Payment from Ph/7408284476@ybl/Paytm
20-02-2023 200.00 206.00
Payments /YBL27efc221c2f8467c8f924d7ebea73be3
UPI/305165022309/Payment from Ph/omshivtiwari864/India
20-02-2023 200.00 6.00
Post Paym/YBL259edf52580449fdb1183b763d8358a4
UPI/341730582286/Payment from Ph/9792230493@ybl/State
20-02-2023 500.00 506.00
Bank Of I/YBL96158ff10cbe47838d5423825d0db9c9
UPI/341787026951/Payment from Ph/9987757743@ybl/Bank
20-02-2023 500.00 6.00
of Baroda/YBL097769a37ad946668def31d3fc5e574d/
UPI/305105362352/Payment from Ph/omshivtiwari864/India
20-02-2023 135.00 141.00
Post Paym/YBL1dd78126f8894b518aa69db377c516fa
UPI/305177753604/Payment from Ph/omshivtiwari864/India
20-02-2023 5.00 146.00
Post Paym/YBLf0959f729cc1488b81e57b633e8a004f
UPI/341761945725/Subscription fo/paytm-31893797@/Paytm
20-02-2023 135.00 11.00
Payments /PTMb017287a05224cd09b67fbcdc67f4781
21-02-2023 BANK CHARGES ECSRTNCHGS051022_SR857956623GST 11.00 0.00
Total: 4,228.00 4,228.00 0.00
 Page 2 of 2 M-24384197-17747

Statement of Transactions in Savings Account XXXXXXXX1503 in INR for the period February 01, 2023 - February 28, 2023

DATE MODE PARTICULARS DEPOSITS WITHDRAWALS BALANCE

22-02-2023 VISA REF GOOGLE PLA 20 02 23 2.00 2.00

UPI/342044581956/Payment from Ph/7408284476@ybl/Paytm
23-02-2023 50.00 52.00
Payments /YBLb228e433f7b140a7b92cf0521de1bd24
UPI/342005776832/Oid202302230953/paytm-66008994@/Pa
23-02-2023 10.00 42.00
ytm Payments /PTM641959625611486ab338cff6efadd668
UPI/305417501193/Oid202302231027/paytm-65341492@/Pa
23-02-2023 20.00 22.00
ytm Payments /PTM54f85f269b5849a396c424da057ea2f1
UPI/305418382435/NA/gpay-1118409574/Axis Bank
23-02-2023 10.00 12.00
Ltd./PTMe44d03a7d7f6463c8523cab995e18d84/
UPI/305491171218/Oid202302231613/paytm-70919485@/Pa
23-02-2023 10.00 2.00
ytm Payments /PTM64278f726a834df89a31d29a1343f67a
UPI/342047372881/Payment from Ph/7408284476@ybl/Paytm
23-02-2023 50.00 52.00
Payments /YBL7cd1f97427e34fdc973aff28da5f8c40
UPI/342072537293/Oid202302231809/paytm-71791036@/Pa
23-02-2023 10.00 42.00
ytm Payments /PTM4564f8ea42974b949873628acca92377
UPI/305457587612/Oid202302231829/paytm-65823289@/Pa
23-02-2023 20.00 22.00
ytm Payments /PTM54a09928e6e0401fafb00d402f5edca6
UPI/342017358227/Payment from
23-02-2023 Ph/satydevkumar862/Paytm Payments 10.00 12.00
/YBL08d66e48ba424ecbbea638720a4529dc
UPI/342067368938/Oid202302232008/paytm-46021425@/Pa
23-02-2023 10.00 2.00
ytm Payments /PTM7a1928e1034e44f9897bdf00a7b1516f
UPI/305610366356/NA/NAGENDRA KUMAR/Paytm
25-02-2023 1.00 1.00
Payments/PTMd9b2c9082fa34dc8b05cd07d53342876/
25-02-2023 BANK CHARGES ECSRTNCHGS051022_SR857956623GST 1.00 0.00
Total: 102.00 102.00 0.00

Account Related Other Information

ACCOUNT TYPE ACCOUNT NUMBER MICR CODE IFS CODE NAME OF NOMINEE*

Savings XXXXXXXX1503 110229078 ICIC0000720 -

* Nominee name is displayed only upon specific consent of the customer.

Sincerely,

Team ICICI Bank Legends for transactions in your Account Statement

VAT/MAT/NFS- Cash Withdrawal at other bank's ATM INF - Internet funds transfer in linked accounts
EBA-Transaction at ICICIDirect BIL - Internet bill payment or funds transfer to third party
VPS/IPS-Debit Card transaction TOP - Mobile Recharge
RTGS-Real Time Gross Settlement (Instant transfer above Rs 2 Lakh) NEFT - National Electronic Fund Transfer

This is a system-generated statement. Hence, it does not require any signature.

You can now download the Account Statement using the iMobile Pay app and Internet Banking.

l There is a revision in the service charge for domestic Savings Accounts w.e.f. Oct 01, 2022. For
details, please visit https://www.icicibank.com/notice-board.page
l There is a change in the Terms and Conditions for Salary Accounts. For details, visit
www.icicibank.com/managed-assets/docs/terms-condition/tnc-savings-account.pdf (Clause XV).
l Bank’s Code of Commitment to its Customers and Micro and Small Enterprises (MSE): Please visit
www.icicibank.com > ‘About Us’ > ‘Notice Board’ > ‘Code of Commitment’. The Code has been
framed in line with the guidelines provided by Banking Codes and Standards Board of India
(BCSBI).
l As per the guidelines issued by CBDT on May 13,2011, Form 16A (TDS Certificates) will be
generated through the Income tax website for which the PAN of the customer needs to be
necessarily updated in the Bank's record.
l Each depositor is insured by the Deposit Insurance and Credit Guarantee Corporation (DICGC) up
to a maximum of Rs. 5 lakh, for both principal and interest amount held by him/her in the same
right and same capacity.
l Do not fall prey to fictitious offers about winning prizes, money circulation schemes, cheap funds, etc.
through SMS, e-mails and calls.
l As per the prevailing guidelines of the Income Tax Act, 1961, if a valid PAN is not provided by the
customer, then the Form 15G/15H shall not be treated as valid and tax shall be deducted at the
prevailing rate or at 20%, whichever is higher. PAN can be updated online or at the nearest branch.
l The address of the customer in Form 16A will be the last updated address in the data base of the
income tax department.
l PMJJBY Insurance: The insurance premium is collected on behalf of ICICI Prudential Life Insurance
Company Limited plus administration charges are collected by ICICI Bank (including GST), in line with
the existing laws. Effective Sep 01, 2018, a premium is charged on a pro-rata basis for all new
enrolments in the scheme. It is noteworthy that the renewal premium for all existing customers shall be
charged for a period of one year (i.e. Rs 330) between May 25 and May 31, every year. For details on
the premium structure, refer to the Terms & Conditions under the Pradhan Mantri Social Security
Schemes at www.icicibank.com .

www.icicibank.com
Corporate Office: ICICI Bank Ltd., ICICI Bank Towers, Bandra-Kurla complex, Mumbai - 400051, India. Category of service: Banking & Financial Services.
Registered Office: ICICI Bank Tower, Near Chakli Circle, Old Padra Road, Vadodara, Gujarat. Pin – 390 007. Registration No. MIV/ST/Bank & Finc/4.
CIN : L65190GJ1994PLC021012
This is an authenticated intimation/statement.
Customers are requested to immediately notify the Bank in case of any error in the statement. SR224512319