Prabhas Tripathi FD Form

FIXED / RECURRING DEPOSIT APPLICATION-CUM-DEPOSIT SLIP
Date : 30/08/2023 Deposit opened at Branch : Branch SOL ID _____________

Customer Details
Existing Bank Account / Customer ID 253901501368 / 531761583
(Customer ID is printed in the welcome kit and appears on the first page of your cheque book; Deposits will be created according to the name
registered under Customer ID.)
Applicant Name : MRS.SARANYA P Senior Citizen : Yes No
Jt. Applicant 1 : _________________________________ (Proof of date of birth is required if not updated in the Customer ID)
Jt. Applicant 2 : ____________________________________________ Mobile Number : +0()919790976111, +0()04400000000
Deposit Details
Type of Deposit : Fixed Deposit Fixed Deposit with Credit Card (Offer valid in select cities. Terms and conditions apply)
Recurring Deposit Tax Saver Fixed Deposit Loan/ Overdraft against Term Deposit
Period of Deposit : 1 Years 3 Months 0 Days. Rate of Interest : 7.1 % per annum
Interest payout option : Cumulative (Interest will be paid on maturity) Quarterly Monthly (Rate of Interest will be discounted)
Deposit Amount : Rs. 150000 (Rupees ONE LAKH FIFTY THOUSAND RUPEES ONLY )
PAN number of First applicant : FQRPS9698C (Mandatory of Deposit amount of Rs 50,000/- & above and Tax Server FD.)
Mode of Operation : Singly Jointly Either or Survivor Former or Survivor Later or Survivor Other
Note : In case applicant proposes to open a Joint FD Account and failed to specify the mode of operation, the same should be as 'Jointly'
Payment Details
Pament Mode and Details of Deposit : Cheque Cash Standing or Debit Instruction
Cash Details Cheque Details
Deno X Pieces Rs. Bank Name: ___________________________________________
______X ______ ______________________________ Branch Name : ___________________________________________
______X ______ ______________________________ Cheque No. : ___________________________________________
Total_________ Rs. __________________________ Amount : ___________________________________________
Debit Instruction / Standing Instruction :
Fixed Deposit : I/We authorize ICICI Bank to debit Rs. 150000 from account no 253901501368 to open a fixed deposit
Recurring Deposit : I/We authorize ICICI Bank to debit monthly installment of Rs. ________________________________from account
No : _____________________________________on______________________day of every month towards Recurring Deposit installment
Interest Payout Option ( For monthly quaterly options only) Maturity Instructions of Fixed / Recurring Deposit
Credit to my ICICI Bank A/C No.______________________ Auto Renew my Fixed Deposit on date of maturity for same tenure
(At prevailing rate of interest) OR
Issue DD/PO in _________________________(Name)
Auto Close my Fixed Deposit on the date of maturity (Tick any one
and payable at _________________________(City) option below)
Transfer fund through NEFT to my account no._________________ Credit to my ICICI Bank account no : _______________
With ________________________________Bank OR
Having IFSC Code _____________________________ Issue DD/PO in __________________________(Name)
and payable at __________________________(City)
Tax to be deducted at Source. No Tax to be deducted at Source.
Please attach Form 15G/15H (for senior citizen) / Tax Exemption Certificate in case tax is not supposed to be deducted at source.
TDS shall be applicable on Fixed Deposits / Recurring deposits placed with the Bank.
Customer Copy
Date : 30/08/2023 Account No/Customer ID : 253901501368 / 531761583 Branch Name _________________________
Type of Deposit : Fixed Deposit Fixed Deposit with Credit Card (Offer valid in select cities. Terms and conditions apply)
Recurring Deposit Tax Saver Fixed Deposit Loan/ Overdraft against Term Deposit
Applicant Name : MRS.SARANYA P Joint Applicants : ____________________
Amount of deposit (In figures) : 150000 Period of Deposit : 1 Years 3 Months 0 Days. Rate of Interest 7.1 % pa
Interest Payout option : Cumulative Quarterly Monthly Maturity Instruction : Auto Renewal Auto Closure
Separate Form 15G/15H has to be submitted every Financial Year to claim exemption from TDS as exemption will be available from the date of
receipt of Form15G/H till the end of the Financial Year.
Bank Officer's Initials : __________________________________
OR For physical copy of receipt please select Issue me/us physical Fixed Deposit Receipt
Note: Enjoy higher returns at prevailing FD interest rate.
Fixed Deposit Receipt

An electronic fixed deposit advice will be sent to the registered email ID within 2 working days from the date the Fixed Deposit Account is
opened/renewed. In case email ID is not registered, mention your email id _________________________________________ (e-mail ID mentioned
should be updated using the Stay Connected Form available at branches for updating as registered e-mail ID for all liability relationships with the
Bank and for all future intents and purposes).
Nomination
I/We have been explained about the benefits of availing nomination facility
I/ We understand that nomination and its details as provided in my Saving/ Current Account with the Bank from which the FD/RD is created
shall also be applicable to such FD/RD
I/We wish to appoint a new nominee for this deposit
I/We do not wish to appoint a nominee for this deposit
Terms and Conditions

a) I/We understand that at the time of placing the fixed deposit, Fixed Deposit Advice shall be issued by ICICI Bank by default, If I/We do not opt for a Fixed Deposit
Receipt and if I/We have opted for auto renewal or auto closure options. An Electronic Fixed Deposit Advice will be sent to the registered e-mail ID within 2
working days from the date the fixed deposit account is created/renewed.
b) I/We agree that the fixed deposit placed by me/us shall be under Auto Renewal, for the original period of the deposit, unless contrary instructions are provided by
me/us any time prior to the date of maturity and as per the mode of opration of the account. However, Fixed Deposit for the Non-Individuals, Tax Saver Fixed
Deposit, Recurring Deposit, Fixed Deposit amounting to Rs. 1Crore and above and such deposits where Fixed Deposit Receipt is issued, auto renewal option shall
NOT be available.
c) In case of auto renewal, as the case may be, interest rate prevailing on the date of auto renewal shall be applicable. For Traditional Fixed Deposit, the principal
deposit amount shall be renewed, while for Cumulative Fixed Deposit the entire maturity proceeds shall be renewed.
d) In case of auto renewal without any change in the existing mode of operation, the respective account opening form be treated as valid and continuing.
e) I/We agree that the proceeds of the deposit will be paid as per existing bank's mode of payment on the due date or on request, before the due date unless the
Deposit id Auto Renewed. I/We understand that premature withdrawal of deposit will be subject to penal rates as per banks policies.
f) I/We understand at the discretion of the bank, loan against the Deposit may be given to the depositor, in whose name the deposit has been opened and who are
authorized to withdraw the deposit, as per original mandate.
g) I/We agree that the first installment shall be debited on the date of opening of the recurring deposit account. Subsequent installments shall be debited on the
selected day of month.
h) I/We agree that in case of delay in payment of any installment, I/We shall be liable to pay monthly interest at the rate of Rs.12 per Rs.1000 or part thereof or such
other rate as may be specified by ICICI Bank for the period of delay.
i) I voluntarily give my consent to ICICI Bank Ltd. for: (a) updating / linking my Aadhaar number as updated in my savings/current account number ___________ with
the present Term / Recurring Deposit that is being opened with Application under my Customer ID/profile (CIF); (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).
j) I have been informed that my Aadhaar details will not be used for any purpose other than the purpose mentioned above or as per requirements of law.
_____________________________ _____________________________ _____________________________

Applicant Signature Joint Applicant 1 Signature Joint Applicant 2 Signature

Prabhas Tripathi FD Form

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FIXED / RECURRING DEPOSIT APPLICATION-CUM-DEPOSIT SLIP

Date : 30/08/2023 Deposit opened at Branch : Branch SOL ID _____________

Fixed Deposit Receipt

I/We wish to appoint a new nominee for this deposit

I/We do not wish to appoint a nominee for this deposit

Terms and Conditions

_______________ _ _______________

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