FATCA/CRS Declaration- Non- Individuals Bar Code: ‘Account Number: Entity Nam ‘A. Is the account holder a Government body or an International Yes/ No Organization like World Bank, WHO, IMF etc. B. Is the account holder a listed entity on a recognized stack exchange Yes/No If “yes” please specify name of stack exchange __ . Isthe account holder an indian Financial institution Yes/No If "yes", please provide your GIN Uf GIIN is not there then provide the reason for not having it) D. Is the account holder tax resident of any country other than India Yes/No If "Yes", then please fill FATCA/ CRS self-certfication form E. Is the entity substantially owned or controlled by persons resident for Yes/No tax purpose in any country outside India or US persons: (Kindly go through the table below and select the appropriate category) 3] Entity ee Controlling Person / Substantial owner Yes No. No. 1 | Company ‘Any natural person holding more than 10% of shares or capital or profits in a company or chain of ownership £2 | Partnership ‘Any natural person holding more than 1036 of the capital or profits of the partnership firm 3 _| Unincorporated ‘Any natural person holding more than 15% of the property or capital association or Body of | or profits of an unincorporated association or body of individuals individuals 4 | Trust ‘Any natural person being the settler of the trust, the trustee, the protector, the beneficiaries with 10% and more interest in the trust and any person exercising ultimate effective control over the trust ‘through a chain of control or ownership where the account holder is atrust 5. Ifthe answer to question ‘Eis Yes but the answer E-1 to E-4 is ‘No’ Yes/ No then Is there any natural person exercising control over the entity ‘through voting rights, agreement, arrangements, etc. or any other means. E6. Ifthe answer to question ‘Eis Yes but the answer E-1 to E-5 is ‘No’ Yes/ No then relevant natural person who holds the position of senior managing official Hany of the above point in section E's ticked as Yes & the controlling persons are resident for tax purpose ‘outside India or US persons then provide FATCA/CRS Self- Certification, Customer Dedaration(Under penalty of perjury, Wwe certify that 1. The applicant is:(i) An applicant taxable as a US person under the laws of the United States of America ("US.") or any state or political subdivision thereof or therein, including the District to Columbia or any other states of the US,, (il) An estate the income of which is subject to U.S. federal income tax regardless of the source thereof. (This clause is applicable only ifthe account holder is identified as @ US person) 2. The applicant is an applicant taxable as a tax resident under the laws of country outside India, (ii) /We understand that the Bank is relying on this information for the purpose of determining the status of the applicant named above in compliance with FATCA/CRS. The Bank is not able to offer any tax advice on FATCA/CRS or its impact on the applicant. I/we shall seek advice from professional tax advisor for any tax ‘questions. (ii) YWe agree to submit a new form within 30 days if any information or certification on this form becomes incorrect. (ivlWWe agree that 25 may be required by domestic regulators/tax authorities the Bank may also be required to report, reportable details to CBDT or clase ar suspend my account. (v) We certify that I/we provide the information on this form and to the best of my/our knowledge and belief the certification is true, correct and complete including the tax payer identification number of the applicant (vi) Ve certify that | have provided the information on this Form to the best of my knowledge and belief and the certification is true, correct, and complete including the taxpayer identification number / functional equivalent number of the Applicant. | am further aware that as per the Union Budget, 2023, a penalty of Rs. 5,000 per account holder shall be levied for furnishing inaccurate statement of financial transaction owing to false or inaccurate self-certification submitted by me under FATCA/CRS. [ [1 /We hereby confirm that details provided are accurate, correct and complete Authorized Signatories and Company Seal (if applicable) Name Date (DD/MM/YYYY)‘Aadhaar Updation Form ‘Annexure to Current Account Opening Form No. The Branch Manager ICICI Bank Ltd, 1.Mr./ Ms... , in my capacity as an [Individual] / [Proprietor / Partner / Authorised Signatory / Beneficial Owner of . (“Account Holder”) hereby voluntarily submit my Aadhaar number .....sessessseree for opening! operating linking below mentioned current account and / or proposed opening of current account with Application No./ Bar code No. specified below. A copy of my duly self-attested Aadhaar card is enclosed. [I hereby provide my voluntary consent for the following: AA). Using my Aadhaar details for verifying and authenticating my identity with UIDAI's Aadhaar based authentication system; B). Updating the Asdhaar details provided by me in the new accounts) being opened with this application form,); C). Use of my registered mobile number to receive SMS alerts from ICICI Bank regarding Aadhaar, and D). Using, exchanging and sharing my Aadhaar details with concerned regulatory and / or statutory authorities as may be sought by them and / or required under applicable law/s. | agree with the below terms pertaining to the ‘purpose’ and ‘sharing’ of my Aadhaar related informatior A). am fully aware that my Aadhaar details will be submitted to Central Identities Data Repository / Unique Identification Authority of India (UIDAI) for authentication, through Yes/No authentication facility (using demographic, OTP, biometric or multifactor authentication) or e-KYC authentication facility (using OTP or biometric authentication), ‘as may be applicable and for updation of Aadhaar details in the account. B). [understand thet, upon authentication, UIDAI may share with ICICI Bank, information in nature of my demographic information including photograph which ICICI Bank may use for KYC verification as identity/address proof for the purpose of account opening. ). Ihave been informed by ICICI Bank that my biometric details shall not be stored by ICICI Bank and shall not be shared with any third party except as provided under applicable laws. D). [have understood that my Aadhaar information submitted to ICICI Bank herewith shall not be used for any purpose other than mentioned above. Thereby understand the following: A) My request for updation of Aadhaar details will not be processed, if l Aadhaar details provided by me is incorrect / incomplete; Il. My details provided for the purpose of opening this Bank account, do not match with details available with UIDAI as a result of which authentication with UIDAI fails; and M-Technical failures while authenticating Aadhaar details with UIDAL B). In case of any correction, dispute, query or complaint regarding the Aadhaar updation, customer(s) shall address the same to the concerned branch. Sincerely, Signature of the Aadhaar holder Micics Bank Most Important Document (MID) Select: Bank/Customer Copy (one copy to be retained by the Bank and other to be given to the customer) Bar Code: _____Iplease quote this bar code for any future reference communication) ‘Account Name: Product suitability gr Annual tumover Metro and Urbs locations Semi Urban Furl eee ry Rooming Suan Account Roorirg Garon Resour x Re <30> lakh to Rs <60> lakh Classic 20 ‘SBA 20 Siver ‘SBA 20 Siver Sense = ? Seloat Cirle Siver/ SBA Fe <60> lak to Rs <120> lah SBA 20 Sitve ‘SBA 2.0 Gold ye Fe <120> loko Rs <000> ‘Soloct Grcle Gold /S8A nn S8A.20 Gold SBA 20 Gold aces ‘More than Re <600> lakh ‘SHA 20 Platinum ‘SBA 20 Patinum SBA 20 Platinum Depending on unique customer business requirements like import/export transactions, new start up, ete, special Variants are available, Please ask the Bank executive to explain the features of the same to you or visit our website wwwicieibankcom, 1._lMWe have understood the Charges applicable to the product variant opted for. Ye also understand that we are Fequited to maintain 3 Monthly Average Balance (MABV/Quarterly Average Balance (QAB) or Total Monthly Throughput (MTP) in the Current Account variant opened by me/us for which ICICI Bank ("the Bank") would provide services, a applicable, free of charges except where otherwise specified in the charges and Non Maintenance charges will be levied as per the service charges applicable without any further notice, if MAB/QAB is less than mentioned. Current Account Variant MABIOAB Me ‘Wor-Miainenance charges (RT We confirm that live have read the Terms & Conditions at www icicibank.com which details the rules governing ‘account operations and amare in possession of the Service Charges applicable, which specifies the charges applicable for various services as mentioned, 3. UWe hereby authorise ICICI Bank to send me mabile or e-mail alerts, as the case maybe, on the mabile number/e ‘mail ID mentioned on Account Opening Form, in accordance with the terms thereof. We undertake that Vive wil submit the PAN details within 30 days of account opening, (We understand and accept that if Iwe fail to do so within the time stipulated by the Bank, the Bank shall have a right to close my/our account, without any further intimation in that regard, 5. UWe confirm receipt of copy of this MID for my/our records. (Signature of Authorised Signatory under the rubber stamp of the firm) Dat: Place: Signature of Bank officer: Employee ID: **Bxcluding GST and other Government taxes 28 applcable, The code of commit f Cl Bonk vale atl branches of CC Bank nd also aval at wr eletbank em. Cod of commiment wlAnnexure 1 PICICI Bank (Declaration format related to the banking exposure) “Date Bor code: {the ‘Entity’) want to open @ Current Account Collection AccountEscrow Account/Cash Credit (CC) Account/Overdraft (OD) Account (pleans ske whictere: ine ‘opplicable). Janet nator guidelines on ‘Opening of Current Accounts by Banks ~ Need for Discipline” dated Aug 06, 2020 ond subsequent Test sven aerstand thot the eligibility to meintain any Current Accounts withthe banks Is oscesteinea rose hence ‘aciities availed from the banking system. hereby decks ee ave net availed any cre facitiesending from other hanks orthe borrowings less thon’ crore. We, ame re are at mylour oggregate exposure becomes equal tofmore than s crore then lave wilinfore ied Sank esa ne same vi e-mailfetter.["] oR tomar ae tat ws have ave cre faites including CCIOD from the banking system and my/our borrowing equal tolmore than ®5 crores} 2a. The exposure of ICICI Bank s more than 10% of mylour eggreqate exposure end 3a! Wie declare ICICI Bank as my/our designatediprimery Bank t9 maintain the Current Account @ [-] 201i We have appointed other Bank os mylar designatedprimary Banke#[ Account © IOC! Bonk is less than 10% of myfour aggregate exposure and hence want to open @ Collection only Account. 3: WMe confirm that Uwe have ovited cect fetes from the banking system without CCIOD, whichis [] 30. Equal tlmore than 85 crore and less than €50 crore [-] 3aii We have exposure with ICICI Bank [-] 3atilWe do not have ony exposure with ICICI Bank and hence want to open a Collection only Account!(-] 3b. Equal tofmore than ® 50 crore(_] 361 We want to ppoin ICC! Bank as the Escrow Managing Bonk] 3b. We want to open a Collection Account* [_] “Me request to set a Standing instruction (SI) in the Account as per the below instructions cat ann CC/O0 Account maincined with the primary banker need to be provided and total funds avilable in this Account willbe transferred in T2 days ‘SiStart date Beneficiary name: Type of balance | Clear Beneficiary Account No Frequency Beneficiary Bank IFSC Time of transfer | BOD/EOD Beneficiary Bank name Rule: Total Fixed Beneficiary $LEI No Jin excess of (Mandatory for Transaction, above 50Cr) [1 *WWe declare tha the tronssetion values mentone fr tls Account wll not exceed ®50 cove desercgk es provided the CCIOD fcilty and its exposure is greater thon 10% and thas been also appcinted as the secant Sematnde ctainng myfour Curent Account. we wil cordingly inform other lenders ta fe calcctens made in the Coecon Account. maintined with the said lenders, willbe transferred on T72 basi tothe CCIOD Anrren ‘maintained with ICICI Bank (Stike oft net applicable} Spteatonnaoce ahem nt te deta provided above ae we ond correct nd tha II Bank reserves the right orl the Account epering ‘pplication in case of any discrepancies secaeere fateby confirm tht n case of opening the Collection Accounts with ICICI Bank, CIC Bank wil ransfer funds ofter recovering the dues of ICICI Bonk including charges. Imerest ony Untucincorec ie oor ha the rght to freezeclase myfour Account incase any Information shored above fe subsequently found to be luteue/incorrect inthe cours of independent reviews conducted by Ici Bark 7 WWWe shall not use the bolance/s inthe Collection Account as @ margin for avaling any non-fund based credit facies + WWehereby undertake thatthe Account will not be used to route withdrawals from the term loans, Vv (Signature of the Authorised Offical with the Entity Stamp) al__ CURRENT ACCOUNT ‘SCHEDULE OF "CHARGES FOR PRIVILEGE PROGRAM a Product Name Product code (Quarterly Average Balance (QAB) in Bae ae Non cash | Particular | Cheque collection and Payment RTGS/NEFT payment done online RTGS Payment (Applicable only if done at branch) _NEFT Payment (Applicable only if done at branch) Business Gold debit card ‘Cheque return — Deposited by Customer Mobile Alert Free DD/PO issuance 15 DD/PO; Max 1500 DD/PO a _ ____Then 2 per/1000 | 150/1 lakh MAB | |Branch transaction Min 100 transaction: Max 3,500 transaction, | - aoe Then 25 per transaction | 150/1 lakh MAB Cheque leaves issuance | Min 100 leaves; Max 2200 leaves | Then 82 per leaf | MAB; Max 1,000 transaction IMPS payment (Applicable for branch and online Then upto 10,000: 3.50/transaction; transaction) 10,001 to 1 lakh: 5/transaction; 1 lakh to 5 lakh: 15/transaction a ae = Cashtransaction ie Paricler oi Cosh deposit at base and non base location; 7 : | Free limit in & @ 10 times MAB Maximum cash deposit free limit per month __2,50,00,000 | "| 3.5/1000 for base and non base location; min Rs. 50 Charges above free limit | pertransaction Cash withdrawal at base lecation _ Free «| i " Free upto 8 10 times of MAB upto Rs. 2.5 crore; | Cash withdrawal at non base location estan | Cheque return ~ Issued by Customer (including fund 18750 per Instrument | transfer) & | | 2 "| Within 14 days - Nil, beyond 14 days but within 6 - 7 | months - % 1,000, beyond 6 months -%500 | Physical statement charge 25 per month ‘ATM cash withdrawal at other bank ATM (India) 21 per transaction ‘Account closure chargesi a Privilege ATM Transactions at other bank ATM (Outside India) 125 per transaction Replacement of lost/stolen debit card, Replacement | ieee % 200 per instance Signature Attestation % 50 per appilication / letter [ECS Debit Return 500 per instance Branch Based transactions including Stop Payment, | Standing Instruction, DD Cancellation, OD Duplicate, | DD revalidation, Duplicate Statement, Bankers! 2 100 per instance Report, Certificate of Balance for Previous Year, Old Record Retrieval, Signature Verification | One time Setup Fee - Rs 5000 Fund Transfer (FT) - Rs Nil, NEFT - Rs 2, RTGS - Rs | -Multipay (Apply from branches) 2, Cheque/DD - Rs 3, IMPS - <25000 Rs 3.5 >25000 Rs | 75 I ey Vy torn omni One time Setup Fee - Ee FT - Nil; NEFT - 1; RTGS + Virtual Account Collection (Apply from branches) _One time Setup Fee - Rs 4000, Re 1 Per Transaction \Virtual Account Collection (Apply through ‘One time Setup Fee - 2000, FT - Nil; NEFT - 1; RTGS - CIB/instaBIZ) 1 ‘One time Setup Fee - Rs 5000,Transaction charges- as per multiple cheque collection Multiple invoice Collection (Apply from branches) Multiple invoice Collection (Apply through | one time Setup Fee - Rs 2000,qransaction charges- CIB/InstaBIZ/Eazypay Portal) | as per multiple cheque collection | One time Setup Fee - Rs 5000, Mandate registration | Rs 12; Tn charges -Rs4__ National Automated Clearing House Private Activity Bonds (Bulk payment without adding ‘eatin uvoranmucan FonmaoA FORM 60/61 3 “consrmm0n © —wowoun® — sole pnorsieron —-«MUF_—=«PARTNERSHIP—=—~PUBLCLTO, _‘TRUSTIASSO/SOC/CLUBS" PrvaTELTD, SECTION25 STATUTORY BODY GOVERNMENT B00Y orwens ony TASS /SGCICbSE: 25061 massamectonoura NGO FOUNDATION “Tobefilledin for Exchange Earner’s Foreign Curreney Account (EEFC account) STATUS — Untinsez uniinst? UntinEHTPT0OWEOU —UntinDTAtorsupphtoSE2 —UnkineFZ IndviuaProfeeonal Orda Resident StaueHolier Others, CURRENCY Uso EURO. cB ary OTHERS: Force crn & mse code ea volunary Code, reflecting te bans postive commitmont Is Mier and Small Emerprise (MSE) customers. Thi Coda nog O ‘only @ Charter of fights ofthe MSE but al enshrines hs obligations visa.vis his bank. Fr more detals pleese Visit wwwcicibank.com" @MAB- Moth Aveoge ance, OTP: Quarter Throughout 0303057 A. @ Presse fin sdetiona personal details in case of individual on Page 0.5 - ca*» PROFILE OF AUTHORISED? SIGNATORY(IES) TO ACCESS AND OPERATE THE ACCOUNT (Please sign in Black Ink only) {Please use anothor Annexure ifthe number of authorised signatories are more than 4), ° Corporate Corporate Sigrwory; | card Access | __sanking | Banking fee = Mesa (35mm 36 mm) ed Deslaaton tna © Post reent pecan sie petograph F rere g We Nr aio $ | (as mmx36 mm) Mooi : Designation 5 — Taos eae a tna sto rocont 5 peewpor g photograph z ere fF tots. E | tssmmeasnm ious & Designation g iin] me 2 Email 1D S| rentoa recent | § passport | = size photograph a here 8 | ccm esemm MMe 8 | sos mmx36 mm Joie a Designation mont Z PLEASE SPECIFY THE MODE OF OPERATION 5 See eee oe cre indent |_Jty_|AsperBoutReriton| cher Sia Z a Te TTT 2 2 occupaton eto ees = 3 Type of Profession Ino ener nat Proteeorad soreess eating Manufactuing ——Agreuturo lated ‘eating © Natur cfBusinon canlneniacmnlacecnaed MutibLevelMarkating Stock Broker eat Estate © NumberofeorsinBusiness Toss aso ea ond SS IS EES