Customer Name Card Account No

MR Deepak Verma 4315 XXXX XXXX 5001

S-221/A
I.T.I COLONY JHANSI
SIDDHESHWAR NAGAR
Industrial Training Institute Jhansi
JHANSI 284003

Statement Period

01/04/2021 TO 31/03/2022

TRANSACTION DETAILS
Card Number : 4315 XXXX XXXX 5001
International
Date Ref. Number Transaction Details Currency
amount
Amount(in `)
16-NOV-21 74766511320145104935540 SAMADHIYA FILLING STAT JHANSI IN 0.00 516.80

17-NOV-21 Reversal of Fuel Surcharge 0.00 -10.00

17-NOV-21 IGST-Rev-CI@18% 0.00 -1.80

18-NOV-21 132221747245 UPI Payment Received 0.00 -1.00

22-NOV-21 132618173478 UPI Payment Received 0.00 -504.00

28-NOV-21 74766511332147790343126 AMAZON RECHARGES HTTPS://WWW.A IN 0.00 5.00

28-NOV-21 74056631333133227748479 Testbook Edu Solutions MUMBAI IN 0.00 3,630.31

30-NOV-21 74056631335133453014156 Dreamplug Technologies Pv BANGALORE 0.00 2.00

IN

30-NOV-21 133429765576 UPI Payment Received 0.00 -100.00

01-DEC-21 INSTANT EMI OFFUS CONVERSION 0.00 0.00

01-DEC-21 74332741337133598458913 HAJI SONS JHANSI IN 0.00 1,010.00

01-DEC-21 Principal Amount Amortization - <1/6> 0.00 587.66

01-DEC-21 IGST-CI@18% 0.00 7.62

01-DEC-21 Interest Amount Amortization - <1/6> 0.00 42.32

01-DEC-21 Testbook Edu Solutions MUMBAI IN 0.00 -3,630.31

01-DEC-21 133589232328 UPI Payment Received 0.00 -5.00

01-DEC-21 133589411445 UPI Payment Received 0.00 -2.00

01-DEC-21 133589591830 UPI Payment Received 0.00 -535.31

The category of service:Credit & Debit Card,Charge Card or Other payment Card service.
RegistrationNo.Mum/Div -III/ST/CDR/23. PAN based STC No:AAACI1195HST001.
REGISTERED OFFICE IS ICICI BANK LIMITED,"LANDMARK",RACE COURSE CIRCLE, VADODARA 390 007 , INDIA.
This is an authenticated intimation/statement.Customers are requested to immediately notify the Bank of any discrepancy in the statement
 TRANSACTION DETAILS
Card Number : 4315 XXXX XXXX 5001
International
Date Ref. Number Transaction Details Currency
amount
Amount(in `)
02-DEC-21 CLICK TO PAY PAYMENT RECEIVED 0.00 -2.29

03-DEC-21 Reversal of fuel Surcharge 0.00 -10.00

07-DEC-21 74332741342134128358741 AMAZON IRCTC MUMBAI IN 0.00 188.05

07-DEC-21 74056631342010896149719 VISHAL MEGA MART KANPUR IN 0.00 498.00

08-DEC-21 134240626237 UPI Payment Received 0.00 -498.00

09-DEC-21 134324593678 UPI Payment Received 0.00 -188.05

10-DEC-21 134429342155 UPI Payment Received 0.00 -1,000.00

10-DEC-21 134429351386 UPI Payment Received 0.00 -7.00

11-DEC-21 74332741346134581383455 AMAZON SELLER SERVICES MUMBAI IN 0.00 546.06

14-DEC-21 74585191349036613892867 PARTH CONSTRUCTIONS AND JHANSI IN 0.00 3,999.00

18-DEC-21 74332741353135298167073 RELIANCE TRENDS JHANSI IN 0.00 1,499.20

18-DEC-21 74332741353135291776318 CITYKART STORES PVT LT JHANSI IN 0.00 181.00

21-DEC-21 74766511355150223059683 VODAFONE IDEA LIMITED HTTPS://MYVI. 0.00 659.00

IN

21-DEC-21 135501560130 UPI Payment Received 0.00 -100.00

22-DEC-21 74332741357135670544804 PRAMOD SERVICE STATION JHANSI IN 0.00 409.05

22-DEC-21 135613196574 UPI Payment Received 0.00 -539.06

23-DEC-21 Reversal of fuel Surcharge 0.00 -4.05

23-DEC-21 74585191358036791102012 SURI AUTOMOBILES JHANSI JHANSI IN 0.00 7,731.00

26-DEC-21 74332741361136060197918 RELIANCE TRENDS JHANSI IN 0.00 899.98

27-DEC-21 CLICK TO PAY PAYMENT RECEIVED 0.00 -539.06

27-DEC-21 136191038681 UPI Payment Received 0.00 -539.06

31-DEC-21 74766511365152900097117 AMAZON RECHARGES HTTPS://WWW.A IN 0.00 15.00

31-DEC-21 74766511365152900093660 AMAZON RECHARGES HTTPS://WWW.A IN 0.00 15.00

31-DEC-21 74766511365152900349070 VODAFONE IDEA LIMITED HTTPS://MYVI. 0.00 539.00

IN

31-DEC-21 136553755721 UPI Payment Received 0.00 -80.00

31-DEC-21 136575109921 UPI Payment Received 0.00 -539.00

31-DEC-21 136575172688 UPI Payment Received 0.00 -300.00

31-DEC-21 136555326426 UPI Payment Received 0.00 -30.00

The category of service:Credit & Debit Card,Charge Card or Other payment Card service.
RegistrationNo.Mum/Div -III/ST/CDR/23. PAN based STC No:AAACI1195HST001.
REGISTERED OFFICE IS ICICI BANK LIMITED,"LANDMARK",RACE COURSE CIRCLE, VADODARA 390 007 , INDIA.
This is an authenticated intimation/statement.Customers are requested to immediately notify the Bank of any discrepancy in the statement
 TRANSACTION DETAILS
Card Number : 4315 XXXX XXXX 5001
International
Date Ref. Number Transaction Details Currency
amount
Amount(in `)
01-JAN-22 Principal Amount Amortization - <2/6> 0.00 594.51

01-JAN-22 Interest Amount Amortization - <2/6> 0.00 35.47

02-JAN-22 IGST-CI@18% 0.00 6.39

08-JAN-22 74766512008201449493112 AMAZON.IN-BILL PAYMENT 0.00 1,776.90

HTTP://WWW.AM IN

08-JAN-22 200888789720 UPI Payment Received 0.00 -1,776.90

08-JAN-22 200890041415 UPI Payment Received 0.00 -10.00

For ICICI Bank Limited.

Sudipta Roy
Head – Consumer Cards

Important Messages
Safe Banking Tips - Do not transact if you find any suspicious device attached to the ATM. Do not take help
from strangers at an ATM.

ICICI Bank Credit Cards Goods and Services Tax Identification Number (GSTIN) is 27AAACI1195H3ZK

HSN Code for service: 9971 - Financial and related services

Our registered office address : ICICI Bank Tower, Bandra Kurla Complex, MUMBAI, Mumbai Suburban,
Maharashtra - 400051

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Please pay your credit card outstanding before the payment due date to avoid penal fees and interest
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For any clarification or more information, you may contact us through the 'Get in Touch' option at
www.icicibank.com

* Mark-up fee and corresponding GST levied is included in the transaction amount displayed

The category of service:Credit & Debit Card,Charge Card or Other payment Card service.
RegistrationNo.Mum/Div -III/ST/CDR/23. PAN based STC No:AAACI1195HST001.
REGISTERED OFFICE IS ICICI BANK LIMITED,"LANDMARK",RACE COURSE CIRCLE, VADODARA 390 007 , INDIA.
This is an authenticated intimation/statement.Customers are requested to immediately notify the Bank of any discrepancy in the statement