Application to update Personal details

(To be submitted with photocopies of self-attested valid passport and relevant documentary proofs).

Date: D D M M Y

To,
ICICI Bank Limited,
NRI HUB,
Autumn Estate, 5th Floor, A Wing
Near Mhada, Chandivali, Andheri (E)
Mumbai 400 072, INDIA

Sub: Request to Update Name/PAN Number/ Contact Number/e-Mail ID/Mobile Number and/or subscribe to e-statements.

Dear Manager,
Please Update my Personal details as mentioned below. My account details are:
Name of Account Holder:
Account Number:
Customer ID:

Please tick appropriate box:

Please Update my name/surname in the account (Please enclose documents as proof of change)
First Name .. Last Name ...................................................
PAN number

(Please enclose Self attested copy of PAN card)

Update My Passport:

(Please enclose Self attested copy of Valid Passport)

Date of Birth D D M M Y

(Please enclose Self attested copy of valid Age proof Document)

My New Contact Number/s (Landline)

Country code

Area code

Number

My New Mobile number

Country code

Number

My New email address: ...........................................................................................

Please send e-statement on my new e-mail ID
Please register my new mobile number on ICICI Banks Mobile Banking service for all my accounts. Also, I Would like to receive all alert
listed on www.icicibank.com that are applicable to my account number/s.
Note:

PAN updation request will be processed provided your Name and Date of Birth in our record matches with NSDL Website.

To update Date of Birth, Please enclose copy of Date of Birth proof.

Central Board of direct taxes has issued a circular dated May13,2011, stating that all form 16A will be generated online through the NSDL
Website. In absence of, Valid PAN, Form 16A will not be generated online through the NSDL Website and further benefit of DTAA will not be
extended.

An e-mail alert on the status of your request would be sent at your registered e-mail id.

Signatures of account holders must match as per bank records. In case of mismatch of signatures, fill the signature update form. <Click here>

Declarations:

I/We agree to update my e-mail/ contact number/PAN/ Date of Birth/ Passport mentioned above in the banks records for any further
correspondence.

I/We agree that any of my account mentioned in customer id is/are dormant/inactive, it will be activated on the basis of this request form.

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I/We agree that in case my/our passport details are not available with bank, photocopies of my/our passports submitted with the application
will be used to update the records.

I/We hereby agree that we have read and understood the terms and conditions instructions available at icicibank.com/nri or/and customer
requisition form from time to time that apply to and regulate the operation of the product and services and facilities mentioned herein above.

Sincerely,

SIGNATURE OF FIRST APPLICANT

(As per bank records)

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