Icici Pay Direct Card PDF Details

If you are a business owner, you know that accepting payments is essential to your success. You may also know that traditional methods of payment, such as check or cash, can be slow and inconvenient. That's where the Icici Pay Direct Card comes in. This card allows businesses to accept debit and credit card payments quickly and easily. In this article, we will explain how to fill out the Icici Pay Direct Card form so that you can start using this payment method today.

If you would like look at various specific details related to the PDF you are going to use, here is the specifics you might want to study prior to completing the icici pay direct card.

QuestionAnswer
Form NameIcici Pay Direct Card
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesicici pay direct card customer care number, how to check icici pay direct card balance, icici bank pay direct card, icici pay direct login

Form Preview Example

Ref No:

Card No:

Branch Code:

DMA Code:

Company PPA Code:

Pricing Code:

Application No. :

Version 3,September 2004.

Pay Direct Card / Meal Card Application Form

FIELDS WITH

ARE MANDATORY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Branch :

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date :

 

 

 

 

 

 

 

 

 

 

 

 

I / We hereby apply for Pay Direct Card / Meal Card with your bank.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DD

 

 

 

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P E R S O N A L D E T A I L S

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

*New Applicant:

 

Mr. / Ms. / Dr.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

First Name

 

 

 

 

 

 

Middle Name

 

 

 

 

 

 

 

Last Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

*Date of Birth :

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DD

MM

 

 

 

YYYY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

*Flat No./Society Name :

*Road No./Name :

*Nearest Landmark :

*City :

*Tel. No. :

STD Code

*Mother’s Maiden Name :

E-mail ID :

*Permanent Address :

C O M M U N I C A T I O N A D D R E S S

(R)

 

 

 

 

 

 

 

 

(O)

 

 

 

 

 

 

 

 

Mobile

 

 

 

 

 

 

 

 

 

 

(This information may be used to verify your identity when you want your card account details over phone.)

*City :

*State :

*PIN :

STD code :

 

 

 

 

 

Tel. :

IDENTITY PROOF

( Verified true copy of any one of the following valid documents duly verified with the originals by a bank official):

Passport

Original Letter of introduction from existing bank

Driving Licence

Voters identity cards

Employee identity cards

PAN Card

Photo Credit Card along with the current billing cycle (latest) statement

Arms licence issued by state/ Central Government of India authority with photograph of applicant

Pension book issued by Government of India with photograph of applicant containing name, address and validity period.

Freedom fighters pass issued by home ministry of government of India with photograph of applicant

For married women, proof of identity with her maiden name, if supported with a verified true copy of marriage certificate are acceptable as valid identity proof.

 

 

* PAN/ GIR No. Of First Applicant :

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FROM 60 / 61 ( TO BE FILED BY THOSE WHO DO NOT HAVE EITHER PAN OR GIR )

 

 

 

 

 

OR

Are you a Tax Assessee

Yes

No

If yes, (a) Details of ward/ Circle/Range ware the last return of income was filed

(b) Reason for not having PAN/GIR No. :

*(Copy of Pancard Mandatory )

I

 

 

do hereby declare that what is stated is true to the best of my knowledge and belief.

Verified at

 

this the

 

day of

 

200

Signature of the declarant

A B O U T Y O U R W O R K

*Name of the Company :

*Department :

*Office Address :

* City :

* STD code :

 

 

 

 

 

Tel. : 1

Address & Signature verified as per the company records

Name of Authorised Signatory :

Tel. : 2

PIN :

Extn. No . :

 

 

Company Official’s Signature Verified

Date :

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature with Seal

 

by the Bank Officer (AM & Above/SE/BDE)

 

DD

 

MM

 

 

YYYY

S I G N A T U R E S A N D P H O T O G R A P H S

Signature of Bank official in whose presence signed

Date :

DDMMYYYY

Applicant’s

Photo

Please affix a recent photograph. Please sign in black ink within the box

Signature of applicant

C A R D C H A R G E S

Card Charges for Rs. 200/- one time fees to be paid in Demand Draft Drawn in favour of “ICICI Bank Limited” and Attach with the Application Form

D E C L A R A T I O N

I have understood and here by agree to the Terms and Conditions as applicable to my Card set forth on the website www.icicibank.com. I understand that Access to any changes/Updating in terms and conditions applicable to this relationship would be available on the website only. I do hereby declare that information furnished in this form is true to the best of my knowledge and belief.

I declare, confirm, agree:

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 have not withheld any information. I understand that certain particulars given by me are required by the operational guidelines governing banking companies. I agree and undertake to provide and further information that ICICI Bank Ltd./its Group Companies may require.

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

That I have read the application form and brochures and am/are aware of all the terms/conditions of availing finance or service or products from ICICI Bank an its group companies and/or its and ICICI Bank.

I agree and understand that ICICI Bank limited / Group Companies reserve the right to reject any application without providing any reason. I agree and understand that ICICI Bank Ltd. /Its Group Companies reserve the right to retain the application forms, and the documents provide therewith, including photographs and will not return the same to me.

I have also read and understood Terms and conditions under which the scheme is offered to my organisation and its employees.

I agree that my employer has full right to revers an instruction given by them for any amount within a period of three working days and I will not dispute or hold the bank responsible for any such debits on the Card.

I understand that it is my responsibility to inform ICICI Bank immediately on termination of my employment with my current employer whereupon I will cease to enjoy any or all benefits under this scheme.

ICICI Bank/its Group Companies or there agents to make references and enquires which ICICI Bank Ltd./ Its Group Companies consider necessary in respect of or relation to information in this application. To inform ICICI Bank & its Group Companies regarding change in my residence / employment and to provide any further information that ICICI Bank & its Group Companies may require from time to time. ICICI Bank Ltd. / its Group Companies to exchange share or part with all the information data or documents relating to my application to other ICICI Group Companies/ Bank/ Financial Instruction / Credit bureaus / Agencies Statutory Bodies such other persons as ICICI Bank Ltd. /Its Group Companies may deem necessary or appropriated as may be required for use or processing of the said information/data by such person or fumishing of the processed information/data/products thereof to other Banks/Financial Institutions / Credit provider /users registered with such persons and shall not hold ICICI Bank Ltd./its Group Companies liable for use of this information

I agree and understand that I have to complete further applications for specific liability products services from ICICI Bank Ltd./ Its Group Companies as prescribed from time to time and that such further application shall be regarded as an integral part of this application and vice versa and that unless otherwise disclosed in such further forms are prescribed the particulars and information set forth herein as well as the documents referred or provide herewith are true, correct, complete and up-to-date in all respect. I agree and understand that such further application will require incorporation of the application form number, and/or such details as ICICI Bank may prescribe, to facilitate data management.

I authorise ICICI Bank Ltd. to issue an ICICI Bank Pay Direct Card / Meal Card / Reimbursement Card to me. I acknowledge that the issue and usage of the Pay Direct Card / Meal Card / Reimbursement Card is governed by the terms and conditions as in force from time to time and agree to be bound by the same. I accept that the terms and condition of Pay Direct Card / Meal Card / Reimbursement Card are liable to be amended by ICICI Bank Ltd. from time to time. I further unconditionally and irrevocably authorise ICICI Bank Ltd. To debit my Account annually with an amount equivalent to the fee and charges for use of the card. I hereby confirm that this account will be operated singly.

The Applicant/s has/have no objection to ICICI Bank Limited, its group companies, agents/representatives to provide me/us information on various products, offers and services provided by ICICI Bank Limited/its group companies through any mode (including without limitation through telephone calls/SMSs/emails) and authorise ICICI Bank Limited, its group companies, agents/representatives for the above purpose.

(Please tick Yes or No, as acceptable to the Applicant/s) : Y:

 

OR N:

 

Signature of Applicant

KYC CERTIFICATION FOR NEW CUSTOMERS

*Name of the Bank Official / SE / BDE

Employee No.

* Date :

DD

MM

YYYY

Signature of Bank Official / SE / BDE and Branch stamp with Branch Code

FOR ICICI BANK USE ONLY

Charged Kit.:

 

 

 

 

Yes

 

 

No

 

 

 

 

 

 

 

Documentation Completed and form submitted on:Date :

 

 

DD

 

 

MM

 

 

 

 

Account Opening Form scrutinized and found in Date :

 

 

DD

 

 

MM

 

 

 

 

order Channel Registration Approved by :

 

 

 

 

 

 

 

Checked by DVU Official at RPC

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date :

 

 

DD

 

 

 

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If rejected, reason:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Form Scanned on :

 

 

Date :

 

 

 

 

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Scanned image transfered on : Date :

 

 

 

 

 

 

 

 

 

 

 

 

 

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SE / BDE / BM / BOM Signature

Signature

Please affix Acknowledgement for WELCOME KIT received from Account holder

Watch Icici Pay Direct Card Video Instruction

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