Pay Direct Card / Meal Card Application Form at a glance
What it is: Pay Direct Card / Meal Card Application Form: you authorise ICICI Bank Ltd. to issue an ICICI Bank Pay Direct Card / Meal Card / Reimbursement Card to you.
Who signs: Please sign in black ink within the box for the Signature of applicant.
A filled-in Pay Direct Card / Meal Card Application Form example: a card application on page one
How to fill out Pay Direct Card / Meal Card Application Form, box by box
Your name and date of birth
Enter Mr. / Ms. / Dr. for the New Applicant, then the First Name, Middle Name and Last Name (fields with * are mandatory, and so is the State on the STD code line).
Enter the Date of Birth : DD MM YYYY (fields with * are mandatory, and so is the State on the STD code line).
Flat No., Road, City, Mobile and Mother's Maiden Name
Under Communication Address, enter the Flat No./Society Name, Road No./Name, Nearest Landmark and City (fields with * are mandatory, and so is the State on the STD code line).
Enter the Tel. No. : STD Code, (R), (O) and Mobile.
Enter the Mother's Maiden Name : this information may be used to verify your identity when you want your card account details over phone (fields with * are mandatory, and so is the State on the STD code line).
Permanent address
Under Permanent Address, enter the address, City, PIN, State, STD code and Tel.
Identity proof
Identity Proof: attach a verified true copy of any one of the following valid documents duly verified with the originals by a bank official. Passport. PAN Card. Original Letter of introduction from existing bank. Photo Credit Card along with the current billing cycle (latest) statement. Driving Licence. 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. Voters identity cards. Employee identity cards.
For married women, proof of identity with her maiden name, if supported with a verified true copy of marriage certificate, is acceptable as valid identity proof.
PAN number
Enter the PAN/GIR No. Of First Applicant (fields with * are mandatory, and so is the State on the STD code line). Copy of Pancard Mandatory.
More rules for Pay Direct Card / Meal Card Application Form
Apply for Pay Direct Card / Meal Card with your bank and enter the Date : DD MM YYYY.
Enter the E-mail ID.
FROM 60 / 61 is to be filed by those who do not have either PAN or GIR. Mark Yes or No for Are you a Tax Assessee. If yes, enter (a) Details of ward/ Circle/Range ware the last return of income was filed. Enter (b) Reason for not having PAN/GIR No.
About Your Work: enter the Name of the Company, Department, Office Address, City and PIN.
Enter the STD code, Extn. No., Tel. 1 and Tel. 2. Address & Signature verified as per the company records.
The Company's Authorised Signatory enters the Name of Authorised Signatory, the Date : DD MM YYYY and the Signature with Seal; the Company Official's Signature is verified by the Bank Officer.
SIGNATURES AND PHOTOGRAPHS: affix a recent photograph under Applicant's Photo.
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 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.
Tick Yes or No, as acceptable to the Applicant/s.
The KYC certification for new customers: the Bank Official / SE / BDE enters the Name of the Bank Official / SE / BDE, the Employee No., the Date : DD MM YYYY and the Signature of Bank Official / SE / BDE and Branch stamp with Branch Code.
Common questions about Pay Direct Card / Meal Card Application Form
Who signs it?
The applicant signs in black ink within the box, on the Signature of applicant line. The Signature of Bank official in whose presence signed, with the Date : DD MM YYYY, is the bank official's line.
Are there fees?
CARD CHARGES: 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.
What am I certifying when I sign?
By signing you say that you have understood and agree to the Terms and Conditions as applicable to your Card set forth on the website www.icicibank.com, you authorise ICICI Bank Ltd. to issue an ICICI Bank Pay Direct Card / Meal Card / Reimbursement Card to you, and you acknowledge that the issue and usage of the Card is governed by the terms and conditions as in force from time to time and agree to be bound by the same. If you file FROM 60 / 61 (to be filed by those who do not have either PAN or GIR), you also declare that what is stated is true to the best of your knowledge and belief, and you fill in the Verified at line and sign on the Signature of the declarant line.
Sources
[1] Pay Direct Card / Meal Card Application Form (the served file; no issuer file found) (the Official source link on this page).
