Icici Bank Neft Form – Fill Out and Use This PDF

Channel Registration Form for Current Account Holders (Only for Individuals/Sole Proprietors)

Account details

FIRST NAME

MIDDLE NAME

LAST NAME

Account Name

Account Number

Statement via Email (free)/Fax (chargeable)

I want my statement via Email (free) Fax (chargeable service) for the above given account number. My contact details are: E-mail ID / Fax no. (If you opt for fax, please include country code [91] and state code [22], e.g. 912256661430 )

1. Email ID/Fax no.

2. Email ID/Fax no.

3. Email ID/Fax no.

4. Email ID/Fax no.

5. Email ID/Fax no.
Tick any one frequency to get email statements:	Daily	Weekly	Fortnightly	Monthly

Email statements will be sent to the above IDs as per the frequency specified below. Linked FD details will be included in the email statements only once a month and shall be sent to the first email ID mentioned above.

Email/Mobile Alerts

I would like to receive the information via mobile alerts through SMS Yes No on mobile no. +91

Email ID for RTGS Alerts

Notes: 1. The maximum number of Email Ids / Fax numbers that can be registered is five. If you have already registered for this service, the earlier email Ids / fax numbers will get updated to the above mentioned details.

2.Mobile alerts provide information on cleared funds in accounts and pertain to Daily Account Balance, Inward / Outward cheque returns, Debits above Rs. 5,000 and Credits above Rs. 5,000.

3.Chargeable: Please refer to the ‘Schedule of Charges’ as statements via Fax and Mobile Alerts are chargeable services.

Applicant details – for Phone Banking/Business Banking Card/Corporate Internet Banking

User 1

User 2

Name of User

(Please do not enter

..........................................................

..........................................................

account name here)

..........................................................

..........................................................

Email ID

.........................................................

PHOTOGRAPH

.........................................................

PHOTOGRAPH

Mobile no.

Signature of user

.........................................................

.........................................................

Account no. if any

A. If the above users are not authorized signatories and are not ICICI Bank account holders, please paste a recent passport size photograph and submit any one of the following documents as identity proof: (1) Valid Passport; (2) Voters Identity Card; (3) Income Tax/Wealth Tax Assessment Order;

(4)PAN Card/PAN Intimation Letter; (5) Driving License; (6) Arm's License; (7) Pension Book; (8) Freedom Fighter's Pass; (9) Letter from Existing Banker B. Signatures of user above should match those in the documents submitted.

Corporate Phone Banking

		User 1		User 2
Access Type	Tick box	Facilities	Tick box	Facilities
Enquiry		Account Information, Linking of FD, Hot listing		Account Information, Linking of FD, Hot listing
		of Debit Cum ATM Card		of Debit Cum ATM Card
		Stop payment and request for a cheque book,		Stop payment and request for a cheque book,
		Opening of FD (creation maximum up to		Opening of FD (creation maximum up to
Transaction		Rs.15 lakh per transaction), Request for DD /		Rs.15 lakh per transaction), Request for DD/
		PO maximum up to Rs. 1.5 lakh, Bank @		PO maximum up to Rs. 1.5 lakh, Bank @
		Home, Fund Transfer instruction in IVR		Home, Fund Transfer instruction in IVR
Business Banking Card (Debit Card) Services
User 1 Required		User 2 Required

A. Business Banking Enquiry Card will be issued for availing enquiry access for Phone banking and View access for Corporate Internet Banking (if the user has not requested for a Business Banking Debit card)

B. Accounts with cash credit/overdraft facility cannot avail transaction access on Phone Banking and will not be issued business banking cards. C. Escrow, Bullion, Interest, Dividend accounts, settlement, EEFC accounts cannot avail transaction access on Phone Banking and will not be

issued business banking cards.

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Corporate Internet Banking (CIB)

		User 1				User 2
Name of User
(max 25 characters)	.......................................................................................................			..............................................................................................................
Do you have any
existing Corporate ID	Yes	If YES, please specify the Corporate ID
for your account
	No	in the adjacent box
(specified in page 1 of
this form)?
Do you have any	Yes	If YES, please specify		Yes		If YES, please specify
		the User Id in the				the User Id in the
existing User ID?	No			No
		adjacent box				adjacent box
Account Number to be
linked to your existing
Corp ID and User ID	...........................................................................................			..................................................................................................
Access Type	Tick box	Facilities		Tick box		Facilities
		Account Information, Trade Finance &				Account Information, Trade Finance & CMS
View		CMS Information, Pull-based Mobile
						Information, Pull-based Mobile Banking
		Banking
Transaction 1		Stop Payment, Request for Cheque				Stop Payment, Request for Cheque book,
		book, Download statements				Download statements
		Opening of FD, Transfer – Own				Opening of FD, Transfer – Own Account,
		Account, Transfer – External to Own
						Transfer – External to Own Account(e.g.
		Account (e.g. Dealer Collection),
						Dealer Collection), Transfer – Own to
		Transfer – Own to External Account
						External Account (e.g. Vendor Payment),
		(e.g. Vendor Payment), Bulk Upload –
						Bulk Upload – Debiting & Crediting
		Debiting & Crediting externally linked
Transaction 2						externally linked account, Bulk Upload –
		account, Bulk Upload – Transfer to any
						Transfer to any ICICI Bank Accounts, Bill
		ICICI Bank Accounts, Bill Payment –
						Payment – ONLINE TAX PAYMENT, Funds
		ONLINE TAX PAYMENT, Funds transfer
						transfer to Non-ICICI Bank Account Holder
		to Non-ICICI Bank Account Holder
						(NEFT and RTGS), Bulk Upload for Inter
		(NEFT and RTGS), Bulk Upload for
						Bank Transfer (NEFT)
		Inter Bank Transfer (NEFT)
Maximum Transaction
Limit (in Rs.)				...............................................................................................
	.........................................................................................
If the limits are not specified, left blank or marked as “unlimited”, the default limit will be Rs. 5 lakh per transaction type.

Documentation required

1.Mandate letter to be given by Sole Proprietorship for all Access Types.

2.Power of Attorney in Bank’s format if user is other than proprietor.

3.For Access type ‘Transaction 2’, Power of Attorney and Indemnity Letter for debit side linking of accounts.

CIB Mode of Operation
Singly	Jointly
Only to be filled when Joint Mode of Operation is selected
	User 1	User 2
Approver's Name
(Checker)
(25 characters)	......................................................................................	............................................................................................

Note: 1. The approvers mentioned should be registered users in CIB.

2.Escrow, Bullion, Interest, Dividend accounts, settlement, EEFC accounts cannot be given transaction access in Corporate Internet Banking.

Important note

Account linking for Corporate Internet Banking

The Bank while opening an account, opens the same under a customer ID. The Client agrees that the account number specified here in above or such account number that would get allotted pursuant to the request for opening of the account, shall be used to identify the Client's customer ID and the account linking for corporate Internet banking would be carried out on the basis of such customer ID. In the event, at any point in time, a customer ID has accounts other than the above referred accounts linked to it, then the user shall be provided access to all such accounts and the Client hereby agrees to such access.

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Declaration

I/We have read, understood and hereby agree to the terms and conditions as applicable to the banking services selected by me/us for the operations of my/our Account(s) as set forth on the website http://ebusiness.icicibank.com/imarkets/common/tocindex.asp and that I/we will adhere to all the terms and conditions applicable..

I /We are aware of charges applicable for banking services and I/we further authorize ICICI Bank Limited to debit my /our Account(s) towards any charges for the selected banking services.

I/We declare, confirm and agree:

a. That all the particulars and information given in this application form (and all documents referred or provided therewith) are true, correct, complete and up-to-date in all respects and I/we have not withheld any information. I/We understand that certain particulars given by me/us are required by the operational guidelines governing banking companies. I/We and undertake to provide any further information that ICICI Bank Ltd. and its Group Companies may require.

b. That I/we have had no insolvency proceedings initiated against me/us nor have I/we ever been adjudicated insolvent

I/We agree, undertake and authorize ICICI Bank Ltd./It's Group Companies to exchange, share or part with all the information, data or documents relating to my/our application to other ICICI Group companies/Banks/ Financial Institutions /Credit Bureaus / Agencies /Statutory Bodies/such other persons as ICICI Bank Ltd. / it's Group companies may deem necessary or appropriate as may be required for use or processing of the said information/data by such person/s or furnishing of the processed information /data/products thereof to other Banks/Financial Institutions/credit providers/users registered with such persons and shall persons and shall not hold ICICI Bank Ltd./its Group companies liable for use of this information.

For

AUTHORIZED SIGNATORY

AUTHORIZED SIGNATORY

(FIRM’S RUBBER SEAL REQUIRED ONLY FOR SOLE PROPRIETOR)

(FIRM’S RUBBER SEAL REQUIRED ONLY FOR SOLE PROPRIETOR)

For ICICI Bank use only

To be filled by Solution Manager / Branch Staff

Channel Staffware Case ID:

Branch/SM Employee Name:

Branch/SM Employee ID:

...............................................................................................

Branch/SM Phone No.:

Sourcing Details

Lead Generator Code

Lead Fulfiller Code

Acquisition Channel Code

Please scan the form through channel staffware at the nearest ICICI Bank branch along with the checklist

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