Application No:

Bar Code:
Sourcing SOL ID:
EC Ledger Code:

Family ID Application Form

Date:
Branch: D D / M M / Y Y Y Y
Name of Primary Member
of Family First Name Middle Name Last Name

Customer ID of Primary Applicant:

Account Number of Primary Applicant:

Is there an Existing Family ID?: Y N

If yes, the Family ID is: Family ID Status:
Request for:
Creating a new Family ID* : Savings Family Silver Savings Gold Privilege Titanium Privilege

Wealth Management Private Banking

Grouping customer IDs to an existing Family ID*

Un-grouping customer IDs from an existing Family ID*

1 2 2
Customer ID to be ungrouped
Product variant selected
Status Code (to be filled in by
branch official)

Closing and Un-grouping all customer IDs from the Family ID*

OTC Upgrade to* : Silver Savings Gold Privilege Titanium Privilege Wealth Management Private Banking

*Customer to sign Tariff Guide as per the new product variant, if

Current product variant of the account is different from the variant of the Family to which the account is being added.
Account is being un-grouped from the Family ID or Family ID is being closed.
Family Member's Details:
Sr. Relationship with Account Opening form No.
Account Number Name of Customer
No. primary applicant (for new applicants)

Declaration :
I/We agree to maintain the FMAB* and (or) FDIV** and (or) FTRV*** prescribed under this product / program.
I/We agree that if I don't maintain the required FMAB, non-maintenance of FMAB charges will be levied.
I/We authorise the Primary Member to provide consent on behalf of me/us for linking a new member to this family or de-linking an existing member from this family anytime in future. I/We
understand that such linking or de-linking shall require, in addition to the signature of the Primary Member, the signature of the member being linked or de-linked, as the case may be.
I/We agree that these conditions are in addition to the terms and conditions as applicable to the Account(s) and available on www.icicibank.com.
I/We hereby agree and confirm that my/our instructions herein shall not be construed as a contract to the contrary in respect of the Bank's right of general lien and set off
On closure of family id, all related benefits will be withdrawn
Bank reserves the right to withdraw the Privilege Banking/Wealth Management/Private Banking status if the operation of the account is not as per the terms & conditions governing the account
I/We hereby agree to abide by the terms & conditions of the new product variant selected upon my/our de-linking from the Family ID.
Signatures:

Sr. Account Number as per the Primary Holder 1st Joint Holder 2nd Joint Holder
No. order in the table overleaf

Sourcing Details
LMS ID: SSE/ST/SE/EMP Code:
LDC/BDE Code: Sourcing Team : HH ERV HH NCA SAL ERV SAL NCA Wealth Private Banking

i. Savings Family: FMAB of Rs.30, 000 to be maintained in the savings account(s) where primary account is in metro/urban location or FMAB of Rs.20,000 to be maintained where primary account is in semi-urban/rural location.
Non-maintenance of the required FMAB in the account(s) in any month will attract a penalty charge as per the following guidelines:
If FMAB is between Rs.30,000 and Rs.20,000, charge of Rs.175# per month will be levied(only for Metro/Urban locations)
If FMAB is between Rs.20,000 and Rs.10,000, charge of Rs.350# per month will be levied.
If FMAB falls below Rs.10,000, charge of Rs.500#per month will be levied.
#FMAB charges for non-maintenance of specified FMAB for the Savings Family shall be waived off provided the member(s) maintain a Fixed Deposit of minimum Rs.1.5 lacs under the same Family ID which they hold with ICICI
Bank in metro/urban locations or a Fixed Deposit of minimum Rs1 lac under the same Family ID which they hold with ICICI Bank in semi-urban/rural locations.

ii. Silver Savings Family: FMAB of Rs.50, 000 to be maintained in the savings account(s).
Non-maintenance of the required FMAB in the account(s) in any month will attract a penalty charge as per the following guidelines:
If FMABis between Rs.50,000 and Rs.20,000, charge of Rs.350# per month will be levied.
If FMAB falls below Rs.20,000, charge of Rs.500# per month will be levied.
#FMAB charges for non-maintenance of specified FMAB for the Silver Privilege Family shall be waived off provided the member(s) maintain a Fixed Deposit of minimum Rs.2.5 lacs under the same Family ID which they hold with
ICICI Bank.

iii. Gold Privilege Family: FMAB of Rs.100,000 to be maintained in the savings account(s).
Non-maintenance of the required FMAB in the account(s), in any month will attract a penalty charge as per the following guidelines:
If FMAB is between Rs.100,000 and Rs.50,000, penalty charge of Rs.175# per month will be levied.
If FMAB is between Rs.50,000 and Rs.20,000, penalty charge of Rs.350# per month will be levied.
If FMAB falls below Rs.20,000, penalty charge of Rs.500# per month will be levied.
#FMAB charges for non-maintenance of specified FMAB for the Gold Privilege Family shall be waived off provided the member(s) maintain a Fixed Deposit of minimum Rs.5 lacs under the same Family ID which they hold with
ICICI Bank.
iv Titanium Privilege Family: FMAB of Rs.125,000 to be maintained in the savings account(s).
Non-maintenance of the required FMAB in the account(s), in any month will attract a penalty charge as per the following guidelines:
If FMAB is between Rs.125,000 and Rs.100,000, penalty charge of Rs.100# per month will be levied.
If FMAB is between Rs.100,000 and Rs.50,000, penalty charge of Rs.175# per month will be levied.
If FMAB is between Rs.50,000 and Rs.20,000, penalty charge of Rs.350# per month will be levied.
If FMAB falls below Rs.20,000, penalty charge of Rs.500# per month will be levied.
#FMAB charges for non-maintenance of specified FMAB for the Titanium Privilege Family shall be waived off provided the member(s) maintain a Fixed Deposit of minimum Rs.6.25 lacs under the same Family ID which they hold
with ICICI Bank.

v. Wealth Management Family: The minimum FDIV** required to be maintained for Wealth Management Family is Rs 25 lac.

vi. Private Banking Family: The minimum FTRV*** required to be maintained for Private Banking Family is more than Rs. 5 crore.

* FMAB (Family Monthly Average Balance) is the sum of Average Monthly Balance maintained by all operative accounts under a Family ID.

** Family Deposit & Investment Value(FDIV) consists of the following products either singly or jointly:
Savings and Current Account Balance Term Deposits Mutual Fund & Life Insurance Holding Value Unredeemed Structured Product / PMS Value at Investment
The above investment should be through ICICI Bank.

*** Family Total Relationship Value is (FTRV) consists of the following products either singly or jointly:
Balances in bank accounts Fixed Deposits Mutual Funds Bonds / Small Savings Investment portion of Life Insurance policies Unit Linked Insurance Policies Private Equity Funds/Structured Products/Realty Funds, etc.
HFC FD Bonds/Small Savings.
The above investment should be through ICICI Bank.

For Office use:

Send to RPC on Signature of Receiving Officer

For Use of RPC

Application No.

Application scrutinized on: Family Id created on

Application rejection date Application re-submission date
Exported: