Section B
Your agreement and authorisation
Registered address - 9 Raffles Place, #50-01 Republic Plaza, Singapore 048619 Company Reg No.T03FC6380G
Section C
(DD MM YYYY) (DD MM YYYY)
Page 2/2
Mode of funding*:
Cheque Cheque No.
Cheque drawn on Date of Cheque
Amount
Cash Amount with currency
NETS Amount in SGD
Wire Transfer Amount
Debit ICICI Bank Current Account Amount
Allocation of initial deposit amount*:
Current Account Savings Account
Term Deposit Currency
Mode of operation for Joint Accounts only: Either or Survivor All to Sign Main Applicant to Sign
By signing below:
1. I/We confirm that the details given above are true, correct and not misleading and that we have read and fully understood a copy of the ICICI Bank's General terms and
conditions governing accounts and secured facilities, (”the Term and Conditions”) which have been made available to me and/or are available on the ICICI Bank's website. I/We
further confirm that we agree to abide such Terms and Conditions. I/We further confirm that I/ We have read and understood, and agree to abide and be bound by the Cash
iers
Orders / Bankers Cheques Terms and Conditions of ICICI Bank, as made available on ICICI Bank's website (www.icicibank.com.sg) and as amended and updated from time to
time. 2. I/We hereby declare and confirm that I/We are the beneficial owner of the Account(s) mentioned hereinabove and of all the funds deposited or will be deposited in the
said Accounts. 3. I/We understand that the approval of this application is at ICICI Bank's sole discretion and without providing any reasons to me/us.In such a case, no contractual
relationship would exist between me/us. 4. I/We agree to
abide and be bound by any amendments, alterations and additions to the Terms and Conditions as may be made from
time to time. I/We consent to disclosures as provided under the said Terms and Conditions and agree that all payments be debited from the Account(s). 5. I/We agree to provide
to ICICI Bank in writing any changes in my/our personal details or circumstances from time to time. 6. I/We authorise ICICI Bank to verify any of the information that I/We have
given to ICICI Bank or my/our credit standing from anyone as ICICI Bank may consider appropriate (such as an authority or credit r
eference agency). ICICI Bank may use other
methods (including credit scoring by electronic or other means) to assess this application and to verify my/our identity. Credit searches and other information which is provided
to ICICI Bank and/or the credit reference agencies, about me/us and those with whom me/us are linked financially may be used by ICICI Bank and other organisations if credit
decisions are made about me/us, or other members of my/our household. This information may also be used for identification purposes, debt tracing and the prevention of
money launderi
ng and countering the financing of terrorism as well as the management of my/our account. 7. I/We agree that ICICI Bank may record and/or monitor my/our
telephone conversations with ICICI Bank for security and training purposes. Any recordings made are ICICI Bank's sole property. 8. I/We agree that the interest rates on deposits
and savings accounts may change periodically. The rate applicable on my/our deposit will be as prevalent on the date of account opening. I/We may check the rates applicable
to my/our deposit on the website link www.icicibank.com.sg. 9. I/We hereby specifically agree and confirm
that the Bank shall be entitled to disclose or procure all information,
including but not limited to the personal data pertaining to me/us as provided in the Terms and Conditions. I/We hereby specifically acknowledge and accept that the clause
24.1 to 24.6 and 24.8 applies to all information of the Customer.
For Joint Accounts only:
1. We agree that ICICI Bank may debit our Joint Account(s) with cheques and other payments authorised by any one of us. 2. We agree that ICICI Bank can update its records
using information given by anyone of us about other(s). 3. We agree that we will be individually as well as jointly liable for any money owed to ICICI Bank.
Notice on Singapore Deposit Insurance
Singa
pore dollar deposits of non-bank depositors are insured by the Singapore Deposit Insurance Corporation, for up to S$100,000 in aggregate per depositor per Scheme
member by law. Foreign currency deposits, dual currency investments, structured deposits and other investment products are not insured. For further information, please visit:
www.sdic.org.sg
Customer declaration (To be filled in by customer)
I/We confirm having received the following:
1) General Terms and Conditions Governing Accounts and Secured Facilities Yes No
2) Schedule of Rates and Charges Yes No
Declaration of Non-evasion of tax and pertaining to Sanctions
To,
ICICI Bank Limited Singapore Branch, 9 Raffles Place, #50-01 Republic Plaza, Singapore – 048619 (“ICICI Bank”)
By signing this application form, I/We, in addition to accepting the Terms and Conditions (as defined above), hereby further affirm, confirm and undertake that
I/We have read, understood and agree to abide and be bound by the GTC (including but not limited to Clauses 41 (OFAC and other sanctions) and Clause 42
(Non-evasion of tax)) of ICICI Bank, as made available on ICICI Bank’s website (www.icicibank.com.sg) and as amended and updated from time to time.
Signature of Individual applicant Signature of Joint applicant
Date (DD MM YYYY) Date (DD MM YYYY)
For Office use only
Date of rec
eiving Application form Branch Official//RM Name DSA ID:
Account Status Code: RET SAL Code: Employee Number:
Branch Sol ID Branch Official Signature
Branch Seal
RB\AO\IND\SAOF\2403