PRELIMINARY CREDIT FACILITY APPLICATION FORM

iSMART Domestic Educational Loans

iSMART International Educational Loans

Education Loans (Excluding iSMART Institutes) Please Affix Please Affix

Recent Recent
✔ PO Program Education Loans
Passport size Passport size

Date : Photograph Photograph

(Self attested) (Self attested)
Loan Amount Required :

For Bank Use Only Existing Relationships with ICICI Group

✔
Application Type* New ✔
Update Loans Credit Card Bank Account
KYC Number (Mandatory for KYC update required)
(Mention Credit Card / Bank A/c / Loan A/c No. above)
✔
Account Type* Normal Simplified(for low risk customers) Small
SOL ID RM Name Employee No. Ref. by .
U
DSA name_______________________________________________ DSE name____________________________________________________
DSA Code Promo Code CRM ID
Channel Name ________________________________________________________________________________________________________
Ref by PB/ VB/ SALARY/ WEALTH/ BLG/ BRANCH/ FOREX________________________________________________________________________

Personal Details of the Applicant (for students)

Prefix First Name Middle Name Surname
Name
Father’s / Spouse Name
Mother’s Name
Applicant’s Maiden Name
✔
Date of Birth D D M M Y Y Y Y Gender: Male Female Transgender Marital status: Married Single Others
✔
Education: Post Graduate Professional Diploma Holder Graduate Under Graduate/ Matriculate
✔
Customer Category: General SC ST OBC MBC Others
✔
Religion: Hindu Muslim Sikh Zoroastrian Christianity Buddhist Others
Current Address

City/ Town/ Village District State Code Pin

Nearest Landmark STD Code Tel
Permanent Address
District State Code Pin
Nearest Landmark STD Code Tel
✔
City/ Town/ Village Location Category: Rural Semi-urban Urban Metro
Mobile No. Email ID
✔
Residential status: Resident Individual NRI PIO Foreign National UID No.

Course Details

Institution/ University(N)

Name of the Course

Duration of Course Yrs Mths Country:

Date of commencement of course Level of Course: ✔

Graduate Post Graduate Professional Diploma

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 ✔
Course Approved by: UGC Govt. AICTE Other Course Stream: Medical ✔
Engineering Management Others
Type of course: ✔
Part time Full time Executive

Education
EducationLoan
LoanDetails
Details
COURSE COST DETAILS FUNDS AVAILABLE DETAILS
Tuition Fees Own Source
Examination Fees Scholarship
Cost of Study Materials Others
Traveling Expenses
Others if any TOTAL 2
TOTAL 1 GRAND TOTAL (TOTAL 1 + TOTAL 2)

Applicant Occupational Details

✔
Occupation: Salaried Self employed/ Business Self employed professional Retired Others
Employer / Business Details
Designation Exp. in Current job/ Business Yrs Months Total Exp. in job/ Business Yrs Months
Emp. ID Previous Employers Name
Comp. / Employers(N)
Company/ Employers
Address

City PIN Code

State Country
Tel(O) Mobile
Personal Details of the Co-applicant
Prefix First Name Middle Name Surname
Name
Father’s / Spouse Name
Mother’s Name
Co-applicant’s Maiden Name
Date of Birth D D M M Y Y Y Y Gender : Male Female ✔
Transgender Marital status: Married Single ✔
Others
✔
Education: Post Graduate Professional Diploma Holder Graduate Under Graduate/ Matriculate
Current Address

City/ Town/ Village District State Code Pin

Nearest Landmark STD Code Tel
Residence is: ✔
Self-owned Rented Company provided Other
No. of years at above residence Years Months, if rented, monthly rent
✔
Residence type: Bungalow(B) Row House(R) Flat(F) Other(O)
Permanent Address
District State Code Pin
Nearest Landmark STD Code Tel
City/ Town/ Village Location Category: ✔
Rural Semi-urban Urban Metro
Mobile No. Email ID
No. of Dependents Alternate E-maiI ID
Gross Income PA UID No.
Relationship with applicant: Father Mother ✔
Brother Spouse Sister Others
✔
Residential status: Resident Individual NRI PIO Foreign National UID No.

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 Occupational Details

PAN/ GIR No. of First Applicant

Form 60/61 Declaration (to be filled in by those who do not have either PAN or GIR)
PAN Card (Applicant) PAN Card (Co-Applicant)
Occupational Details
✔
Occupation: Salaried Self employed/ Business Self employed professional Retired Others
Employer / Business Details
Designation Exp. in Current job/ Business Yrs Months Total Exp. in job/ Business Yrs Months
Emp. ID Previous Employers Name

Comp. / Employers(N)
Company/ Employers
Address

Landmark
City PIN Code
State Country
Tel(O) Mobile
Official e-mail ID Other monthly income
✔
Office Ownership Self Owned Parental Relatives Rental Pagdi Others

Assets & Liabilities

Assets Applicant Co-applicant Liabilities Applicant Co-applicant
Bank1 Bank 2 Bank1 Bank 2 Home Loan Bank
Bank Balance Home Loan Amount
BB Amount Vehicle/ PL Bank
Bank Deposit Vehicle/ PL Amount
BD Amount EL Bank
Immovable properties Education Loan Amount
Mutual Funds Credit Cards
Others Others

Bank Account details

Particulars Applicant Co-applicant
Account number
Type
Name of the bank
Bank Branch

Details of security offered

Security offered : Yes ✔ No
Type of Property: Residence Commercial ✔ Plot FD Others Specify_____________
Project approved by ICICI Bank, Yes ✔
No
Property Owned by _______________________________ Current Value ___________________________

Address

Proof of Address (POA) Applicant

CURRENT / PERMANENT / OVERSEAS ADDRESS DETAILS (Certified copy of any one of the following POA needs to be submitted)
✔
Address Type Residential / Business Residential Business Registered Office Unspecified
Proof of Address Aadhar* Driving licence Passport Voter ID Card NREGA Job Card Other
✔
Simplified Measures account - Document Type code
(*other OVDs are applicable only where the address mentioned in Aadhaar is not the current address of the customer)

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 Proof of Identity (POI)(Certified Copy of anyone of the following POI needs to be submitted)
APPLICANT CO-APPLICANT

A - Aadhar No.*
* other OVDs are applicable only where the address mentioned * other OVDs are applicable only where the address mentioned
in Aadhaar is not the current address of the customer in Aadhaar is not the current address of the customer

B - Voter ID Card

C - PAN Card
or Form 60 Form 61 or Form 60 Form 61

E - Passport Number
D D M M Y Y Y Y D D M M Y Y Y Y
Expiry Date

D - Driving Licence
Expiry Date D D M M Y Y Y Y D D M M Y Y Y Y

F- NREGA Job Card

Z - Other
Identification Number
S - Simplified Document Type code Document Type code
Measures Account
Identification Number

Proof of Address (POA)

CURRENT / PERMANENT / OVERSEAS ADDRESS DETAILS (Certified copy of any one of the following POA needs to be submitted) Co-applicant
Address Type ✔
Residential / Business Residential Business Registered Office Unspecified
Proof of Address ✔
Aadhar* Driving licence Passport Voter ID Card NREGA Job Card Other
Simplified Measures account - Document Type code
(*other OVDs are applicable only where the address mentioned in Aadhaar is not the current address of the customer)
Current address (correspondence /local address): State/U T code : ISO 3166 Country code:
Permanent address : State/U.T code: ISO 3166 Country code: Overseas Address: ISO 3166 Country code:
TICK IF APPLICABLE RESIDENCE FOR TAX PURPOSES IN JURISDICTION(S) OUTSIDE INDIA
Place / City of Birth ISO 3166 Country code of Jurisdiction of Residence
Tax Identification Number or equivalent (if issued by jurisdiction) ISO 3166 Country Code of Birth

Reference

1. Name Relationship

Address
E-mail ID Phone
( Preferably friend/ colleague)
2. Name* Relationship
Address
E-mail ID Phone
( *Compulsory one reference should be relative)

Checklist Of Document Sharing

Applicant Co-Applicant Additional Co-Applicant Guarantor
2 Color Photos 2 Color Photos 2 Color Photos 2 Color Photos
Photo ID Photo ID Photo ID Photo ID
Residence Proof Residence Proof Residence Proof Residence Proof
Date of Birth Proof Date of Birth Proof Date of Birth Proof Date of Birth Proof
Signature Verification Signature Verification Signature Verification Signature Verification
Academic Documents 8 Months Bank Statement 8 Months Bank Statement Income Proof
Proof of Admission Income Proof Income Proof Collateral Documents
Fees Structure Collateral Documents Collateral Documents
Relationship Proof Relationship Proof

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 KYC Certification (To be filled by Bank Official / Sourcing Agent)

I ____________________________ with employee ID/ VSTS Code ____________________________ do hereby confirm that I have met Applicant /
Authorised Signatory in person at his / her office / residence on __________________________ (mention date) and confirm that I have verified the copies of
documents (as applicable) against original as produced by the applicant. I also confirm that Applicant(s) have signed this application form in my presence.

Signature of Bank Official / Outsourced Executive: ____________________________________

Declaration
I/We 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 authorize ICICI
Bank Limited, its group companies, agents/ representatives for the above purpose. Please tick Yes or No, as acceptable. Yes No

Common Declarations
1. I / We declare that all the particulars and information and details given/filled in this 7. I/We authorize ICICI Bank Limited (ICICI Bank) to exchange, share or part with
application form are true, correct, complete and up-to-date in all respects and that all the information and details relating to my/our existing loan and/or repayment
I/We have not withheld any information whatsoever. history to other ICICI group companies, banks, financial institutions, credit
2. I hereby declare that the details furnished above are true and correct to the best of bureaus, statutory bodies, such other Agencies enrolled by ICICI Bank for the
my knowledge and belief and I undertake to inform you of any changes therein, purpose of providing the products and services as may be required or they may
immediately misrepresenting. I am aware that I may be held liable for it. I hereby deem fit and shall not hold ICICI Bank (or any of its Group Companies or its/their
consent to receiving information from Central KYC Registry through SMSs/ Email agents / representatives) liable for use / sharing of this information.
on the above registered number/ email address. 8. I / We understand and acknowledge that ICICI Bank shall have the absolute
3. I / We confirm that no insolvency proceedings or suits for recovery of outstanding discretion, without assigning any reasons (unless required by applicable law),
dues or monies whatsoever and/or any criminal proceedings have been initiated to reject our application and that ICICI Bank shall not be responsible/liable in any
and/or are pending against me/us and that I/We have never been adjudicated manner whatsoever to me/us for such rejection or any delay in notifying me/us
insolvent by any court or other authority. of such rejection and any costs, losses, damages or expenses, or other
4. No action nor other steps have been taken or legal proceedings started by or consequences, caused by reason of such rejection, or any delay in notifying me/
against me/ us in any court of law/other authorities for winding up, dissolution, usof such rejection, of our application.
administration or reorganization or for the appointment of a receiver, administrator, 9. Except to the extent disclosed to ICICI Bank, no director or relative/near relation
administrative receiver, trustee or similar officer or for my/our assets. (as specified by RBI) of a director of a banking company (including ICICI Bank)
5. I / We declare that I/We have not made any payment in cash, bearer cheque or kind or arelative/near relation (as specified by RBI) of a senior officer of ICICI Bank
along with or in connection with this application to the executive collecting my/our (as specified by RBI) is: the Applicant(s), or a partner of our concern, or a
application. I / We shall not hold ICICI Bank liable for any such payment made by us trustee,member, director, manager, employee of our concern or of our
to the executive collecting this application. subsidiary, or ourholding company, or a guarantor on my/our behalf, or holds
6. I/We understand and confirm that the Application form and all other documents substantial interest inour concern or my/our subsidiary or holding company.
submitted by me/us to ICICI Bank shall not be returned to me/us to ICICI Bank 10. I hereby authorize ICICI Bank to validate my Aadhar details from UIDAI.
shall have the right to retain the same in accordance with ICICI Bank Ltd’s
internal policy and applicable laws and regulations.

SPECIMEN SIGNATURE(Applicant) SPECIMEN SIGNATURE(Co-Applicant)

Details of the Charges

Interest Rate * % per annum

Processing Fee ( one time ) *

Prepayment charges *
Other charges *

(*subject to change as per bank discretion from time to time)

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 Aadhaar Updation Consent Form

The Branch Manager Date D D M M Y Y Y Y

ICICI Bank Ltd.,

______________________(Branch Name)

I, Mr./Ms.,___________________________________,in my capacity as an Individual / Proprietor / Partner / Authorised Signatory / Beneficial Owner of

_____________________________________________________________________, (“Account Title”) hereby voluntarily submit my Aadhaar number
_______________________________________for opening of account (with Application No./ Bar code No. specified below) and / or linking / updating
Aadhaar No in the below mentioned account(s).A copy of my duly self-attested Aadhaar card is enclosed.

Bar Code No. /

Customer ID Application No. / Account Title Type of Account
Account No.

1 I voluntarily give my consent to ICICI Bank Ltd. for: (a)Using my Aadhaar details for authenticating my identity with UIDAI's Aadhaar based authentication
system and obtaining demographic details (including photograph) from UIDAI; (b) Use of my registered mobile number to receive SMS alerts from ICICI Bank
regarding Aadhaar; and (c) Sharing my Aadhaar details with UIDAI, concerned regulatory and / or statutory authorities as may be required under applicable
law(s).

2 I have been informed that: (a) my Aadhaar details(including my demographic information) shared by UIDAI will not be used for any purpose other than the
purpose mentioned above or as per requirements of law; and (b) my biometric information will not be stored by the Bank.

3 I hereby understand that My request for updation of Aadhaar details will not be processed, if (a) Aadhaar details provided by me is incorrect;
(b) authentication with UIDAI fails due to mismatch of my details with UIDAI; (c) there is technical failure while authenticating Aadhaar details with UIDAI.

Sincerely,

Signature of the Aaadhar holder

Enclosure: Copy of duly self-attested Aadhaar card

Acknowledgment Receipt

To,

ICICI Bank has received your application of Rs

Please note that the processing of your application may take upto 15 working days after receipt of the completed application form with requisite documents.
In case of queries, please contact:
Relationship Manager Number
Sales Executive/ DSA Number
Authorised Official
Email-ID or contact our customer care

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 ANNEXURE (Co-Applicant/ Guarantor)

Personal Details of the Co-applicant

Prefix First Name Middle Name Surname
Name
Father’s / Spouse Name
Mother’s Name
Date of Birth D D M M Y Y Y Y Gender: ✔
Male Female Transgender Marital status: Married Single Others
✔
Education: Post Graduate Professional Diploma Holder Graduate Under Graduate/ Matriculate
Current Address

City/ Town/ Village District State Code Pin

Nearest Landmark STD Code Tel
✔
Residence is: Self-owned Rented Company provided Other
No. of years at above residence Years Months, if rented, monthly rent
Residence type: ✔
Bungalow(B) Row House(R) Flat(F) Other(O)
Permanent Address
District State Code Pin
Nearest Landmark STD Code Tel
City/ Town/ Village Location Category: Rural Semi-urban Urban Metro
Mobile No. Email ID
No. of Dependents Alternate E-maiI ID
Gross Income PA UID No.
Relationship with applicant: ✔
Father Mother Brother Spouse Sister Others
✔
Residential status: Resident Individual NRI PIO Foreign National UID No.

Occupational Details
✔
Occupation Salaried Self employed/ Business Self employed professional Retired Others
Employer / Business Details
Designation Exp. in Current Job/ Business Yrs Months Total Exp. in Job/ Business 'JLJJLJL Yrs Months
Emp. ID Previous Employers Name
Comp. / Employers(N)
Company/ Employers
Address

Landmark
City PIN Code
State Country
Tel(O) Mobile
Official e-mail ID
✔
Office Ownership Self Owned Parental Relatives Rental Pagdi Others
PAN/ GIR No. of Co-applicant / Guarantor

PAN Card Form 60/61 Declaration (to be filled in by those who do not have either PAN or GIR)

Bank Account details

Particulars Co-applicant / Guarantor
Account number
Type
Name of the bank
Bank Branch

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 Proof of Identity (POI) Co-applicant / Guarantor
(Certified copy of any one of the following POI needs to be submitted)

A. Aadhar* (*other OVDs are applicable only where the address mentioned in Aadhaar is not the current address of the customer)

B. Voter ID Card C. PAN Card*

D. Driving Licence Expiry Date D D MM Y Y Y Y
E. Passport Number Expiry Date D D M M Y Y Y Y

F. NREGA Job Card

Z. Other (any document notified by government) Identification Number
S. Simplified Measures Account- Document Type Code Identification Number

Proof of Address (POA) Co-applicant / Guarantor

CURRENT / PERMANENT / OVERSEAS ADDRESS DETAILS (Certified copy of any one of the following POA needs to be submitted)

Address Type Residential / Business Residential Business Registered Office Unspecified

Proof of Address Aadhar* Driving licence Passport Voter ID Card NREGA Job Card Other
Simplified Measures account - Document Type code
(*other OVDs are applicable only where the address mentioned in Aadhaar is not the current address of the customer)
Current address (correspondence /local address): State/U T code : ISO 3166 Country code:
Permanent address : State/U.T code: ISO 3166 Country code: Overseas Address: ISO 3166 Country code:
TICK IF APPLICABLE RESIDENCE FOR TAX PURPOSES IN JURISDICTION(S) OUTSIDE INDIA
Place / City of Birth ISO 3166 Country code of Jurisdiction of Residence
Tax Identification Number or equivalent (if issued by jurisdiction) ISO 3166 Country Code of Birth

Details of the Charges

Interest Rate * % per annum

Processing Fee ( one time ) *

Prepayment charges * Nil

Other charges *
(*subject to change as per bank discretion from time to time)

References Co-applicant / Guarantor

1. Name Relationship
Address
E-mail ID Phone
( Preferably friend/ colleague)

2. Name* Relationship
Address
E-mail ID Phone
( *Compulsory one reference should be relative)

Please Affix
Recent SPECIMEN SIGNATURE(Applicant)
Passport size
Photograph
(Self attested)

SPECIMEN SIGNATURE
3 (Co-applicant/ Guarantor)

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 KYC Certification (To be filled by Bank Official / Sourcing Agent)

I ____________________________ with employee ID/ VSTS Code ____________________________ do hereby confirm that I have met Applicant /

Authorised Signatory in person at his / her office / residence on __________________________ (mention date) and confirm that I have verified the

copies of documents (as applicable) against original as produced by the applicant. I also confirm that Applicant(s) have signed this application form in my

presence. Signature of Bank Official / Outsourced Executive: ____________________________________

Declaration
I/We 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 authorize ICICI
✔

Common Declarations
1. I / We declare that all the particulars and information and details given/filled 7. I / We authorize ICICI Bank Limited (ICICI Bank) and all its group
in this application form are true, correct, complete and up-to-date in all respects companies and their agents to exchange, share or part with all the
information and details relating to my/our existing loans and/or repayment
and that I/We have not withheld any information whatsoever. history to other ICICI group companies, banks, financial institutions, credit
2. I hereby declare that the details furnished above are true and correct to the best bureas, agencies, statutory bodies etc. as may be required or as they may
of my knowledge and belief and I undertake to inform you of any changes deem fit and shall not hold ICICI Bank (or any of its group companies or its/
therein, immediately misrepresenting. I am aware that I may be held liable for their/ agents/ representatives) liable for use / sharing of this information.
8. I / We understand and acknowledge that ICICI Bank shall have the
it. I hereby consent to receiving information from Central KYC Registry through absolute discretion, without assigning any reasons (unless required by
SMSs/ Email on the above registered number/ email address. applicable law), to reject our application and that ICICI Bank shall not be
3. I / We confirm that no insolvency proceedings or suits for recovery of responsible/liable in any manner whatsoever to me/us for such rejection or
outstanding dues or monies whatsoever and/or any criminal proceedings any delay in notifying me/us of such rejection and any costs, losses,
damages or expenses, or other consequences, caused by reason of such
have been initiated and/or are pending against me/us and that I/We have
rejection, or any delay in notifying me/us of such rejection, of our
never been adjudicated insolvent by any court or other authority. application.
4. No action nor other steps have been taken or legal proceedings started by 9. Except to the extent disclosed to ICICI Bank, no director or relative/near
or against me/ us in any court of law/other authorities for winding up, relation (as specified by RBI) of a director of a banking company (including
dissolution, administration or reorganization or for the appointment of a ICICI Bank) or a relative/near relation (as specified by RBI) of a senior
officer of ICICI Bank (as specified by RBI) is: the Applicant(s), or a partner
receiver, administrator, administrative receiver, trustee or similar officer or of our concern, or a trustee, member, director, manager, employee of our
for my/our assets. concern or of our subsidiary, or our holding company, or a guarantor on
5. I / We declare that I/We have not made any payment in cash, bearer cheque my/our behalf, or holds substantial interest in our concern or my/our
or kind along with or in connection with this application to the executive subsidiary or holding company.
10. I hereby authorize ICICI Bank to validate my Aadhar details from UIDAI.
collecting my/our application. I / We shall not hold ICICI Bank liable for any
such payment made by us to the executive collecting this application.
6. I / We understand and confirm that the Application form and all other
documents submitted by me/us to ICICI Bank shall not be returned to
me/us and ICICI Bank shall have the right to retain the same.

SPECIMEN SIGNATURE(Applicant) SPECIMEN SIGNATURE(Co-Applicant/ Guarantor)

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