1. Customer identification details
Business name
Doing business as
Place of incorporation (specify state and country)
Date of incorporation
Tax Payer Identification Information
Social Security No. (SSN)
OR Employer Identification No. (EIN)
Address (PO box not acceptable)
Mailing address
City State Country
Zip
Business Phone number Fax number
Email ID Website
Principal office address (if different from mailing address)
Principal Office address
City State Country
Zip
Business Phone number
Fax number
2. Product details
Average monthly anticipated activities
Type Checking account
Incoming Outgoing
No. of Checks
Total Value Checks ($)
No. of Domestic Wires/ACH
Total Value Domestic Wires/ACH ($)
No. of International Remittances
Total Value International Remittances ($)
Trade transactions
(please specify trade type)
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Product type Certificate of deposit Checking account
Initial deposit amount (USD)
Tenure (months) Not applicable
Type of account
Fixed interest rate
Floating interest rate
Non-interest bearing
Interest payout
Quarterly
Monthly
Annually
Cumulative
Not applicable
Certificate of Deposit Trade Account Syndicated Loan Bilateral Loan
Checking Account
Type of account
ICICI Bank Limited, New York Branch
575, 5th Ave, Suite 2600, New York, NY 10017
Tel: +1 (646) 827 8450 / e-Fax: +1 (646) 358 4521
www.icicibankusa.com
Account Opening Form (Business Non-FDIC insured)
FORM NO: NYL/002/VER.002
Debit existing ICICI Bank Limited, New York Branch account:
Remittance from India/other country
Check/ACH
Amount in USD
Mode of funding
Internet banking
Checkbook
Services opted for
(provide account no.
)
Purpose of Opening the Account:
Business Background (please include a brief about the company and its operations):
Countries for Anticipated Transactions:
Source of Funds
Types of Transaction Expected (Domestic/International; Vendor Payments/ Collection, Salary, Taxes, Others - Please Specify):
S Corporation
Limited Liability Company (LLC) or (PLLC)
Partnership (General or Limited LLP)
Sole proprietorship
Business type
3. Business details
Corporation (Inc. or Corp.)
Others
Government Entities
Nature of business
Type of industry
NAICS Industry Code
Business’ previous year annual revenue (USD)
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Information on existing ICICI Group relationships
Account name Account number Relationship type Location
Ownership information of business
Please provide information for all owners who hold an interest of 25% or more in shares or other voting interests in non-publicly held corporations
or partnerships.
Business owner 1
Name
% ownership
Country of citizenship SSN
Date of birth
CityHome Address
State
Country Zip Phone Number
Previous address (if present address is less than 24 months old)
StateCity Country Zip
Business owner 2
Name
% ownership
Country of citizenship SSN
Date of birth
CityHome Address
State
Country Zip Phone Number
Previous address (if present address is less than 24 months old)
StateCity Country Zip
Business owner 3
Name
% ownership
Country of citizenship SSN
Date of birth
CityHome Address
State
Country Zip Phone Number
Previous address (if present address is less than 24 months old)
StateCity Country Zip
Business owner 4
Name
% ownership
Country of citizenship SSN
Date of birth
CityHome Address
State
Country Zip Phone Number
Previous address (if present address is less than 24 months old)
StateCity Country
Zip
Page 3 of 7
Account signatory 1
Name
Country of citizenship
SSN
Date of birth
CityHome Address
State
Country
Zip
Phone Number
Previous address (if present address is less than 24 months old)
StateCity Country
Zip
Government ID no.
Email ID
Issue Login ID/password for Corporate Internet Banking
SIGNATURE..............................................................................
4. Account signatories
Any one to sign All to sign Others
Account signatory 2
Name
Country of citizenship
SSN
Date of birth
CityHome Address
State
Country
Zip
Phone Number
Previous address (if present address is less than 24 months old)
StateCity Country
Zip
Government ID no.
Email ID
Issue Login ID/password for Corporate Internet Banking
SIGNATURE................................................................................
Account signatory 3
Name
Country of citizenship
SSN
Date of birth
CityHome Address
State
Country
Zip
Phone Number
Previous address (if present address is less than 24 months old)
StateCity Country
Zip
Government ID no.
Email ID
Issue Login ID/password for Corporate Internet Banking
SIGNATURE..............................................................................
Account signatory 4
Name
Country of citizenship
SSN
Date of birth
CityHome Address
State
Country
Zip
Phone Number
Previous address (if present address is less than 24 months old)
StateCity Country
Zip
Government ID no.
Email ID
Issue Login ID/password for Corporate Internet Banking
SIGNATURE.................................................................................
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5. Privacy Notice
At ICICI Bank Limited, New York Branch we take your privacy very seriously and take precautions to maintain it. We do not sell customer lists or individual customer information.
We collect, retain and use your information only where we reasonably believe it will be useful or necessary in performing the functions of a financial institution, such as providing
products and services to you.
Policies and procedures have been instituted to protect your personal financial information and to maintain the privacy of personal information relating to your relationship with
ICICI-New York. These include controls, which limit access to consumer information, procedures to ensure the maintenance of accurate information and privacy covenants in third-
party service and business agreements. ICICI Bank Limited, New York maintains up-to-date physical, electronic and procedural safeguards that comply with federal standards to
guard against unauthorized access to your non-public, personal information.
We may share the information collected from or about you with our affiliates for such purposes as are permitted or required under applicable law and policy.
In other cases, we may join with non-affiliated financial institutions to provide you with joint products or services. Although it may be necessary for us to share with these other
financial institutions certain information we collect about you, we will never share your account(s) or access code(s) for these purposes.
The information we provide to outside companies in either of these two circumstances will be limited to that which is necessary for them to do their job. These companies are
required to keep your information secure and use it only as authorized by us. Under the law, you are permitted to opt-out of: (1) our sharing of non-transactional information about
you with our affiliates under the federal Fair Credit Reporting Act; and (2) our sharing information about you with non-affiliated companies and persons other than those to whom
we have outsourced specialized services and those with whom we have joint marketing agreements. However, since we do not currently share such information, no opt-out action
is necessary or provided. Should our policy change, you will be notified and given an opportunity to opt-out.
If you would like to have a copy of the Privacy Notice, or require additional information or have any questions regarding ICICI-NY’s privacy Policy, please telephone us at
1-866-424-2448 or send us an e-mail.
6. Business resolution
“The business entity shall provide the Branch with a Business resolution (if applicable) for opening an Account pursuant to this Application. This shall be in a format prescribed /
satisfactory to the Branch."
7. Indemnity relating to instructions given by fax, telephone, and other forms of Electronic Communication
Notwithstanding anything to the contrary contained in any other document/ agreement, I/we hereby request and authorize you to act and rely on any instructions or communications
for any purpose (including but not limited to the instructions/communications pertaining to the operation of all my/our accounts or to any other facilities or services that may be
provided by you from time to time) which may from time to time be or purport to be given by telephone, facsimile, untested telexes and faxes, telegraph, cable or any other form of
electronic communication by me/us (including such instructions/communications as may be or purport to be given by those authorized to operate my/our account(s) with you)
(“Instructions”). I/We understand and acknowledge that there are risks involved in sending the Instructions to you via telephone, facsimile, untested telexes and faxes, telegraph,
cable or any other form of electronic communication and hereby agree that all risks shall be fully borne by me/us and I/we assume full responsibility for the same, and you will not be
liable for any losses or damages arising upon your acting, or your failure to act, wholly or in part in accordance with the Instructions. In consideration of your agreeing, subject to the
terms and conditions hereunder, to act upon the Instructions as aforesaid, I/we hereby irrevocably agree and undertake:
a. that you shall be entitled to act or refuse to act as you see fit, without incurring any liability whatsoever to me or to any other person, upon any instructions for any purpose which
may from time to time be or purport to be given by telephone, facsimile, untested telexes and faxes, telegraph, cable or any other form of electronic communication by me/us
(including such instructions as may be or purported to be given by those authorized to operate my/our account(s) with you, even if such instructions or communications are not
followed up by written confirmation to you.
b. That the instructions shall be conclusively presumed for your benefit to be duly authorized by and legally binding on us, and we shall be fully responsible for the same. You shall
not be responsible to ensure the authenticity, validity or source of any instructions and shall not be liable if any instructions turned out to be unauthorized, erroneous or fraudulent.
c. Not to make any claim against or hold you liable by reason of or on account of you having acted or refused to act on any instruction or you having acted wrongly or mistakenly or
of your failure to act wholly or in part in accordance with the instructions.
d. That you shall be entitled (but not obliged) to keep records of our instructions given or made by telephone, facsimile, untested telexes and faxes, cable or any other form of
electronic communication in such form, physical or electronic, as you may in your sole discretion deem fit, and your records shall be conclusive and binding on me/us. You shall be
entitled to dispose of or destroy any such records at any time as determined by you at your sole discretion.
e. That you shall be authorized to disclose all instructions as you may deem fit, to your affiliates, counterparties, service providers, and regulators and other authorities or where you
are required by law to do so.
f. That you shall be entitled to require any instruction in any form to be authenticated by use of any password, identification code or test as may be specified by you form time to time
and I/we shall ensure the secrecy and security of such password, code or test and I/we shall be solely responsible for any improper use of the same.
g. That not withstanding the above, you may under circumstances determined by you in your absolute discretion, require from me/us confirmation of any of any instructions in such
form as you may specify before acting on the same and we shall submit such confirmations to you immediately upon receipt of your request. Pursuant to receipt of instructions, you
shall have the right but not the obligation to act upon such instruction.
h. That you shall not be liable to us or any third party for, and that I/we (jointly and severally) shall indemnify you and keep you indemnified from and against all claims either by me
or any other, actions, demands, liabilities, costs, charges, damages, losses, expenses and consequences of whatever nature (including legal fees on a full indemnity basis) and
howsoever arising, which may be brought or preferred against you or that you may suffer, incur or sustain by reason of or on account of your having so acted whether wrongly or
mistakenly or not, or of your failing to act wholly or in part in accordance with the instructions and the terms of this letter.
i. That I/we confirm that I/we have the capacity and authority to accept this document and that this document constitutes our valid, legal, effective and enforceable obligation.
j. That this undertaking cum indemnity document shall be governed and construed in accordance with the law’s of New York and I/we hereby irrevocable submit to the non-exclusive
jurisdiction of federal and state courts located in the Boroughs of Manhattan, New York.
8. Acknowledgment
1. We consent to:
(i) the terms and conditions governing bank accounts in the U.S. as well as the terms and conditions contained in the Customer Account Agreement, receipt of which is
hereby acknowledged; and
(ii) inform you promptly of changes, if any, in the mode of operation of the account, and/or the names of authorized signatories for the account.
2. We understand that on no occasion will our account be permitted by the Branch to go into overdraft.
3. We have read and understood the Privacy Notice and Indemnity relating to instructions given by fax, telephone, and other forms of Electronic Communication
(above) and agree to be bound by the same.
4. The information provided in this application is correct to the best of our knowledge and belief.
5. We understand that any checking or other deposit account that we establish with the Branch is not covered by deposit insurance from the Federal Deposit Insurance
Corporation (“FDIC”).
Date
ACCOUNT SIGNATORY 1 ACCOUNT SIGNATORY 2 ACCOUNT SIGNATORY 3
ACCOUNT SIGNATORY 4
.......................................................................
.....................................................................................................................................................................................................................
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9. Disclosure statement
To help the government fight the funding of terrorist and money laundering activities, Federal law requires all financial institutions to obtain, verify and record information that
identifies each person or business that opens an account.
What this means to you: When you open an account, we will ask for your name, address, date of birth, identification numbers like Social Security or ITIN etc., and identification
documents like driver’s license, passport or any other document that will help us identify you.
For US citizens or US resident aliens (W-9)
Under penalties of perjury, I certify that
(a) the number shown on this form is my correct tax identification number (or I am waiting for a number to be issued to me), and
(b) I am not subject to backup withholding because:
1. I am exempt from backup withholding;
2. I have not been notified by Internal Revenue Services that I am subject to backup withholding as a result of failure to report all interest or dividends; or
(c) the IRS has notified me that I am no longer subject to backup withholding
Certification instruction: You must cross item 2 above if you have been notified by IRS that you are currently subject to backup withholding tax because of under reporting interest
or dividend on your tax return. For real estate transaction, item 2 does not apply. I intend to meet the substantial presence test for the calendar year pursuant to IRC § Section 7701
(b)(3)(A) to qualify as a resident alien.
For non-resident aliens (W-8) - Attach a complete copy of the appropriate W-8 form.
Signature of U.S. person Date
10. Checklist at the time of account opening (please read this before filling out the form)
• Provide any one of the following based on the type of entity:
1. Certificate of Incorporation
2. Partnership Agreement
3. LLC Operating Agreement
4. Current Tax Registration Certificate
5. Certificate of good standing
• All fields in the form are mandatory
• If applicable, DBA Certificate
• For a non US entity please provide the appropriate W8 form
• Business Resolution format – as per the annexure that has been
provided
• Any more information to be provided on a separate blank page
• ID proof for signatories / owners
11. Funding instructions – amount in USD
By Check Wire Transfer instructions
To - Bank Name Bank of New York Mellon, New York
Field 56 – Swift Code IRVTUS3N (Intermediary bank)
For Credit to Account Number 8900676973
Field 57 - Beneficiary Bank ICICI Bank Ltd., New York
Payable to “ICICI Bank Ltd, New York Branch a/c
‘Your full name’”
For example “ICICI Bank Ltd, New York Branch
a/c John Smith”
Final beneficiary
“Your full name as mentioned in this application, New
Account”. For Example – “John Smith, New Account”
Completed application forms to be mailed to:
ICICI Bank Limited, New York Branch, 575, 5th Ave, Suite 2600, New York, NY 10017
For ACH Debit or Credit transactions
Routing number - BONYM (Bank of New York Mellon) 021-000-018
Customer Account number (for ACH transactions only) 30000XXXXXXXXXXXX (12 digit account number prefixed by 30000)
For (Customer Name) it would be XXXXXXXXXXX
Completed application forms to be mailed to :
ICICI Bank Limited, New York Branch, 575, 5th Ave, Suite 2600, New York, NY 10017
If you are wiring money using a third party account, you must mention the name and address of the third party in the form.
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12. For ICICI Bank use only
Sourcing by Risk assessment by OFAC & ID check by
Name Name Name
Employee no.
Employee no. Employee no.
Date Date Date
Face to face
Non Face to Face
Customer exempt category
Signature
Signature
Signature
Customer Account details
Account number
Customer ID
Annexure – Business Resolution (not for sole proprietor). This has to be provided on the letterhead of the business
Resolution of the
Board of Directors of Partners of
Officers/Members of
Having its chief executive office at
The Business resolves that:
1. The Business appoints ICICI Bank Limited, New York Branch (“ICICI Bank”) as the Bank of business.
2. Subject to paragraph 6, the directors, partners or members (as applicable) of the Business do, from time to time, authorize .........................., [and ......................................., either
jointly or severally]1 an “Authorized Individual” to do any of the following:
(a) Deposit, withdraw or order transfer of funds from the Business’ bank account by means made available by ICICI Bank from time to time and as set out in the Customer Account
Agreement;
(b) Execute and deliver any agreements or other documents or instruments with or in favor of ICICI Bank, or give any authority to ICICI Bank required in connection with the banking
business of the Business whether generally or with regard to any particular transaction, instrument or agreement, including without limitation, ICICI Bank’s Customer Account
Agreement, as such Customer Account Agreement may be amended by ICICI Bank from time to time;
(c) Receive statements, instruments and other items and documents relating to the Business’ accounts with or any services of ICICI Bank (including any revisions to ICICI Bank’s
rules, manuals of operations or terms and conditions) and to settle and certify the Business’ accounts with ICICI Bank;
(d) Receive from ICICI Bank any software and any security devices, including security cards, codes, personal identification numbers and passwords relating to electronic banking
services or electronic communications or communications by telephone between the Business and ICICI Bank;
(e) Avail of the “Corporate Internet Banking” facility provided by ICICI Bank;
(f) Avail of the financial, monetary and any other products and services as may be offered by ICICI Bank through the Corporate Internet Banking facility on behalf of the Business and
to do all such acts and deeds and to execute all such documents as are necessary in connection with the Corporate Internet Banking Facility;
(g) Generally to exercise all rights, powers and authorities which the business may exercise under the authority of the constating documents and by-laws (if applicable) of the
Business and the laws and regulations relating to or affecting the Business.
3. The provisions contained in any agreement, document or instrument entered into and delivered to ICICI bank, including without limitation, ICICI bank’s Customer Account
Agreement, as such Customer Account Agreement may be amended by ICICI Bank from time to time, including without limitation the provisions concerning the binding effect of
electronic and telephonic communications received by ICICI Bank from or in the name of the Business, and the performance by the Business of its obligations there under, are
hereby expressly authorized, sanctioned and approved.
4. Only authorized signatories are permitted to transact on any accounts of the Business held at ICICI Bank and are hereby authorized for and on behalf of the business to do any of
the things and deliver, from time to time, any of the agreements, documents or instruments, as the case may be, set forth in paragraph 2 of this Resolution.
5. Subject to paragraph 6, all instructions, acts and things done and documents, agreements and instructions executed on behalf of the business in accordance with the foregoing
and delivered to ICICI Bank by 2[the/ any] Authorized Individual shall be valid and binding upon the Business, [whether or not executed under corporate seal]3, and shall be
enforceable against the Business and may be rolled and acted upon by the ICICI Bank.
6. Subject to the Customer Account Agreement, the Business may appoint any other authorised individual and revoke the appointment of the Authorized Individual duly appointed
herein only by executing a resolution that is duly and validly authorized and binding on the business.
7. The Business shall provide ICICI Bank with a certified copy of this resolution. ICICI Bank is entitled to rely on the certified copy of this resolution as duly and validly authorized and
binding on the Business. ICICI does not need to make any further inquiry into the authority of the undersigned to bind the business.
8. There are no provisions in the constating documents, by-laws, unanimous shareholders agreements, documents governing the formation and governance of the business or any
other agreement, document or instrument to which the Business is bound which restrict, limit or regulate in any way the powers of the Business, or the powers of the directors,
partners, members/officers(as applicable) on behalf of the Business, to do any of the acts and execute any of the documents referred to in the Customer Account Agreement (as
such may be amended by ICICI Bank from time to time).
Certificate
The undersigned ...................................................................... being a/the .............................................. of the Business, hereby certifies on behalf of the Business that the foregoing is a
true copy of a resolution properly passed by the board of directors of the corporation, partners of the partnership, or officers/members of the group (as applicable) of the Business
and that the said resolution is now in full force and effect as unamended as the date thereof.
Date
SIGNATURE.....................................................................................
1 To be suitable modified by the entity.
2 To be suitable modified in accordance with footnote 1 above.
3 To be amended based on the Articles of Association of the entity.
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