Customer Name Card Account No

MR ASHU DHAWAN 4375 XXXX XXXX 3005

ICICI PRUDENTIAL LIFE INSURANCE COMPANY
LTD 3RD FLOOR PLOT NO-32 CENTRAL MALL
AMRITSAR 143001

Statement Period

01/04/2022 TO 31/03/2023

TRANSACTION DETAILS
Card Number : 0000 XXXX XXXX 2669
International
Date Ref. Number Transaction Details Currency
amount
Amount(in `)
29-AUG-22 Autodebit Payment Recd. 0.00 -2,877.00

30-JAN-23 Autodebit Payment Recd. 0.00 -892.00

28-FEB-23 Autodebit Payment Recd. 0.00 -3,259.69

28-MAR-23 Autodebit Payment Recd. 0.00 -3,018.56

28-MAR-23 IGST-CI@18% 0.00 4.50

28-MAR-23 feelevy204219832703 Reward redemption handling 0.00 25.00

fee-Ord.No.204219832703 dtd 20022

TRANSACTION DETAILS
Card Number : 4375 XXXX XXXX 3005
International
Date Ref. Number Transaction Details Currency
amount
Amount(in `)
27-APR-22 74332742118211724511004 RED TAPE SHOES AMRITSAR IN 0.00 900.00

27-APR-22 74332742118211724726313 RED TAPE SHOES AMRITSAR IN 0.00 2,000.00

28-APR-22 74332742119211854956523 BAJWAS BEST OILS KATHUNANGAL IN 0.00 1,010.00

09-MAY-22 220394633447 INFINITY PAYMENT RECEIVED, THANK YOU 0.00 -3,910.00

19-MAY-22 74332742140213972625314 KISSAN FILLING STATION AMRITSAR IN 0.00 1,010.00

29-MAY-22 74766512149221998557752 RISHABH FOUR WHEELS PR AMRITSAR IN 0.00 6,069.79

01-JUN-22 220410562808 INFINITY PAYMENT RECEIVED, THANK YOU 0.00 -7,079.79

23-JUN-22 74332742175217448981977 TUNG POWER POINT AMRITSAR IN 0.00 1,010.00

27-JUN-22 74585192179040214603122 SHARMA FILLING STATION KAPURTHALA 0.00 1,010.00

IN

The category of service:Credit & Debit Card,Charge Card or Other payment Card service.
RegistrationNo.Mum/Div -III/ST/CDR/23. PAN based STC No:AAACI1195HST001.
REGISTERED OFFICE IS ICICI BANK LIMITED,"LANDMARK",RACE COURSE CIRCLE, VADODARA 390 007 , INDIA.
This is an authenticated intimation/statement.Customers are requested to immediately notify the Bank of any discrepancy in the statement
 TRANSACTION DETAILS
Card Number : 4375 XXXX XXXX 3005
International
Date Ref. Number Transaction Details Currency
amount
Amount(in `)
18-JUL-22 220447330104 INFINITY PAYMENT RECEIVED, THANK YOU 0.00 -2,020.00

19-JUL-22 74332742201220080637400 SUDARSHAN FILLING STAT AMRITSAR IN 0.00 505.00

20-JUL-22 24537632201045088745744 BPCL TUNG POWER POINT_2 AMRITSAR IN 0.00 2,023.60

23-JUL-22 74332742205220484108814 DOABA PETROMART KAPURTHALA IN 0.00 1,010.00

04-AUG-22 74585192217040860432895 C S D CANTEEN 11 ARMD AMRITSAR IN 0.00 1,568.00

04-AUG-22 74679692217000872000557 FLAMING ARROW UNIT RUN AMRITSAR IN 0.00 756.00

04-AUG-22 74585192217040860456951 C S D CANTEEN 11 ARMD AMRITSAR IN 0.00 553.00

05-AUG-22 220461486732 INFINITY PAYMENT RECEIVED, THANK YOU 0.00 -3,538.60

14-AUG-22 74585192227041050067176 CORAL RIVER RESORT PVT GURDASPUR IN 0.00 2,800.00

06-SEP-22 220484929459 INFINITY PAYMENT RECEIVED, THANK YOU 0.00 -2,800.00

28-SEP-22 74332742272227164865371 HANGRIES AMRITSAR IN 0.00 430.00

28-SEP-22 74332742272227169025278 HANGRIES AMRITSAR IN 0.00 586.00

18-OCT-22 220516663135 INFINITY PAYMENT RECEIVED, THANK YOU 0.00 -1,016.00

19-OCT-22 74585192293042035793372 PANTHER CANTEEN AMRITSAR IN 0.00 717.00

19-OCT-22 74585192293042036041920 PANTHER CANTEEN AMRITSAR IN 0.00 379.00

26-OCT-22 74585192300042152068963 C S D CANTEEN 11 ARMD AMRITSAR IN 0.00 629.00

26-OCT-22 74585192300042151997287 C S D CANTEEN 11 ARMD AMRITSAR IN 0.00 2,183.00

28-OCT-22 74332742303230162893463 GOODWILL FILLING STATI AMRITSAR IN 0.00 505.00

09-NOV-22 220533570578 INFINITY PAYMENT RECEIVED, THANK YOU 0.00 -4,413.00

19-NOV-22 74679692324000923772881 NEELKANTH FILLING STATION AMRITSAR 0.00 1,011.80

IN

20-NOV-22 74164522325001446870608 BROTHERS DHABA AMRITSAR IN 0.00 830.00

09-DEC-22 220555712415 INFINITY PAYMENT RECEIVED, THANK YOU 0.00 -1,841.80

18-DEC-22 24028022353000823934430 MSW*AMAN ARORA Amritsar IN 0.00 1,500.00

21-DEC-22 74766512355250044048721 O R SERVICE STATION AMRITSAR IN 0.00 1,011.80

22-DEC-22 Rev of HPCL Surcharge Rev 0.00 -10.00

22-DEC-22 IGST-Rev-CI@18% 0.00 -1.80

05-JAN-23 230575397632 INFINITY PAYMENT RECEIVED, THANK YOU 0.00 -2,500.00

07-JAN-23 74332743008300741663723 BARISTA BATALA IN 0.00 892.00

17-JAN-23 74332743018301701362288 B P 21 COCO RETAIL OUT RAYYA IN 0.00 1,010.00

The category of service:Credit & Debit Card,Charge Card or Other payment Card service.
RegistrationNo.Mum/Div -III/ST/CDR/23. PAN based STC No:AAACI1195HST001.
REGISTERED OFFICE IS ICICI BANK LIMITED,"LANDMARK",RACE COURSE CIRCLE, VADODARA 390 007 , INDIA.
This is an authenticated intimation/statement.Customers are requested to immediately notify the Bank of any discrepancy in the statement
 TRANSACTION DETAILS
Card Number : 4375 XXXX XXXX 3005
International
Date Ref. Number Transaction Details Currency
amount
Amount(in `)
03-FEB-23 74332743035303420332120 ADVANCE CITY ELECTRONI AMRITSAR IN 0.00 24,990.00

03-FEB-23 230596282150 INFINITY PAYMENT RECEIVED, THANK YOU 0.00 -1,010.00

06-FEB-23 INSTANT EMI OFFUS CONVERSION 0.00 0.00

06-FEB-23 ADVANCE CITY ELECTRONI AMRITSAR IN 0.00 -24,990.00

06-FEB-23 Principal Amount Amortization - <1/9> 0.00 2,631.94

06-FEB-23 IGST-CI@18% 0.00 35.82

06-FEB-23 Interest Amount Amortization - <1/9> 0.00 332.99

06-FEB-23 IGST-CI@18% 0.00 59.94

06-FEB-23 Processing Fee 199 : 0% 0.00 199.00

06-MAR-23 IGST-CI@18% 0.00 53.63

06-MAR-23 Interest Amount Amortization - <2/9> 0.00 297.92

06-MAR-23 Principal Amount Amortization - <2/9> 0.00 2,667.01

For ICICI Bank Limited.

Sudipta Roy
Head – Consumer Cards

Important Messages
Safe Banking Tips - Do not transact if you find any suspicious device attached to the ATM. Do not take help
from strangers at an ATM.

ICICI Bank Credit Cards Goods and Services Tax Identification Number (GSTIN) is 27AAACI1195H3ZK

HSN Code for service: 9971 - Financial and related services

Our registered office address : ICICI Bank Tower, Bandra Kurla Complex, MUMBAI, Mumbai Suburban,
Maharashtra - 400051

Making only minimum payment every month can lead to repayment stretching over years with consequent
interest payment on outstanding balance

Please pay your credit card outstanding before the payment due date to avoid penal fees and interest
charges.

The category of service:Credit & Debit Card,Charge Card or Other payment Card service.
RegistrationNo.Mum/Div -III/ST/CDR/23. PAN based STC No:AAACI1195HST001.
REGISTERED OFFICE IS ICICI BANK LIMITED,"LANDMARK",RACE COURSE CIRCLE, VADODARA 390 007 , INDIA.
This is an authenticated intimation/statement.Customers are requested to immediately notify the Bank of any discrepancy in the statement
For payments made through cheque, we request you to make the payment atleast 3 working days before the
due date incase of an ICICI Bank cheque and 5 working days before the due date for Non-ICICI Bank cheques.

For any clarification or more information, you may contact us through the 'Get in Touch' option at
www.icicibank.com

* Mark-up fee and corresponding GST levied is included in the transaction amount displayed

The category of service:Credit & Debit Card,Charge Card or Other payment Card service.
RegistrationNo.Mum/Div -III/ST/CDR/23. PAN based STC No:AAACI1195HST001.
REGISTERED OFFICE IS ICICI BANK LIMITED,"LANDMARK",RACE COURSE CIRCLE, VADODARA 390 007 , INDIA.
This is an authenticated intimation/statement.Customers are requested to immediately notify the Bank of any discrepancy in the statement