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    Stay Connected Address Change Form

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    नित्यानंद पाटील
    This document is a request form from a customer to update their contact details, including address, phone number, email, PAN, and Aadhar details, across various accounts and policies they hold with ICICI Bank. The customer provides their updated information and declares that the information is true and correct. They authorize the bank to share their Aadhar details with relevant authorities. The bank official verifies the customer's identity and signatures before processing the request to update records.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Stay Connected Address Change Form

    Uploaded by

    नित्यानंद पाटील
    343 views2 pages
    This document is a request form from a customer to update their contact details, including address, phone number, email, PAN, and Aadhar details, across various accounts and policies they hold with ICICI Bank. The customer provides their updated information and declares that the information is true and correct. They authorize the bank to share their Aadhar details with relevant authorities. The bank official verifies the customer's identity and signatures before processing the request to update records.

    Original Description:

    document to fill by indian people

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    This document is a request form from a customer to update their contact details, including address, phone number, email, PAN, and Aadhar details, across various accounts and policies they hold with ICICI Bank. The customer provides their updated information and declares that the information is true and correct. They authorize the bank to share their Aadhar details with relevant authorities. The bank official verifies the customer's identity and signatures before processing the request to update records.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    343 views2 pages

    Stay Connected Address Change Form

    Uploaded by

    नित्यानंद पाटील
    This document is a request form from a customer to update their contact details, including address, phone number, email, PAN, and Aadhar details, across various accounts and policies they hold with ICICI Bank. The customer provides their updated information and declares that the information is true and correct. They authorize the bank to share their Aadhar details with relevant authorities. The bank official verifies the customer's identity and signatures before processing the request to update records.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    Service Request No.

    :
    Date :

    No. 1

    Stay Connected
    (Update your latest contact details/Address/PAN/AadharNumber For Resident Individuals)
    Customer Details: Customer ID
    *

    Bank Account :

    Demat Account:

    I-direct Account:

    Credit Card:

    Loan:

    ICICI Prudential Policy:

    (Please fill in all the details in CAPITAL LETTERS and use BLACK INK only. Fields with * (asterisk) are mandatory)
    * Name: Mr./Ms./Mrs./Dr.
    (Primary Applicant):

    First Name

    Middle Name

    Last Name

    Customer Declaration
    Please revise my/our records/contact details with your Bank for the accounts that are held by me or us
    New Communication Address:

    City:
    Pin code:

    State:
    Tel No. (res.):

    Tel No. (office):

    *Mobile No:

    *I confirm having checked my mobile number and understand that all SMS alerts/ transactions, one time passwords (OTP) will
    be received on above mentioned mobile number.
    ** E-mail ID :
    **I wish to register for E-mail statement :

    Yes

    No

    If your new communication address is different from your permanent address, please give the details below:
    Permanent Address:

    City:
    Pin code:

    State:
    Tel No. (Res.):

    Tel No. (office):


    # For change of address, please submit relevant address proof which will be verified with the original by officials.
    (A) I wish to update details in my ICICI Prudential policy number: Yes

    No

    (B) If you do not want your savings account statements sent to your communication address, please tick here.
    PAN Updation: Please update my PAN

    in the above mentioned account.(The copy of PAN

    as document proof is enclosed for the Bank's records)


    (D) Unique Identification number (Aadhar) Updation: Please update my Aadhar Number
    in the above mentioned saving bank account. (The copy of Unique ID card as document proof is required)
    1. I authorize Unique Identification Authority of India (UIDAI) to release my demographic details (Including e-mail id and mobile number)
    to ICICI Bank through biometric authentication which ICICI Bank may use for KYC verification (In case of KYC)
    2. I understand that Aadhar card number updated in bank A/c will be shared with National Payment corporation of India (NPCI) for
    receiving direct benefit transfer credits.

    Checking your account balance or requesting a mini statement, banking is now easy as messaging a friend. With SMS, you can
    stay in touch with your account with just a few key words. Simply SMS the following keywords to 5676766 or 9215676766
    Balance Inquiry
    : SMS IBAL
    >> last 6 digit of account>>
    Last transactions
    : SMS ITRAN >> last 6 digit of account>>
    Cheque book request : SMS ICBR
    >> last 6 digit of account>>
    Last transactions
    : SMS ISCR
    >> last 6 digit of account>>
    Last transactions
    : SMS ICSI
    >> last 6 digit of account>>

    I/We hereby understand that:

    All the particulars filled in the form are true, correct, complete and up-to-date in all respects and no information is
    withheld

    I/We understand that certain particulars given by me/us are required as per the operational guidelines governing
    banking companies

    ICICI Bank reserves the right to reject the request for updating Change of address/Mobile number/E-mail ID/PAN
    updation /Aadhar Number /Mobile Banking facility for one or more of the products/services without assigning any
    reason

    If incomplete or inaccurate information is given, ICICI Bank, before rejecting/accepting any of the above request for
    any of its products, has the right to ask for additional documents

    It is my/our responsibility to inform ICICI Bank immediately if there is any change in the address/mobile number/
    E-mail ID mentioned herein and to provide further information as may be required by ICICI Bank

    Mobile Banking facility is not offered for jointly operated accounts

    I/We confirm and undertake that I/We have read and understood the Terms and Conditions governing the mobile
    banking facility of ICICI Bank as mentioned/specified on www.icicibank.com

    # I confirm that I have the necessary authority/mandate from all the joint account holders to sign this declaration on behalf of
    myself and all the joint holders for all the products and services mentioned herein

    Customer Signature (s) :

    Signature

    Signature

    Signature

    Name

    Name

    Name

    *(Primary Applicant)

    *(Joint Applicant 1)

    *(Joint Applicant 2)

    Branch Use Only


    Declaration by Branch Official I confirm
    The details match with the Bank's records
    The applicant(s) signed in my presence and the signature(s) have been verified with the Bank records
    Documentary proof is enclosed (If the account activation date is less than 6 months from the date of application)
    All documents are verified with original and attested
    Account is not Inactive / Dormant / Frozen / in Debit balance
    Address change authorised
    Identity proof is attached for the mobile banking facility
    For ICICI prudential policy address updation, applicants address proof obtained additionally
    For updation in Demat account / I-direct account
    Linked Bank Account No.
    Trading user ID (for ICICI Direct.com account only)

    Employee ID:

    Bank
    Seal

    ______________________________

    Signature of Bank Official: ______________________________


    ICICI/RSPPG/V2/0716/LIAB/STAYCONNECTED

    Acknowledgement Slip (To be filled by the Bank staff)


    Date :
    Received from ___________________________ Ac/ No./ Policy No. ______________________________________for change of address
    contact details/e-mail/PAN/Mobile alert/Aadhar number for your:
    Bank Account

    Demat Account

    ICICI Direct

    Credit Cards

    Loans

    ICICI Prudential policy

    The necessary changes will be carried out in the Banks records only for the account mentioned above.
    ICICI Bank (Branch Name):__________________________________
    Signature of Bank Official: __________________________________

    Bank
    Seal

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