FIXED / RECURRING DEPOSIT APPLICATION-CUM-DEPOSIT SLIP

Date: Deposit opened in Branch: Branch SOL ID

Customer Detail
Existing Bank Account / Customer ID____________________________________________________
___________________________________________________________________________________
(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: ___________________________________________________________________________ Senior Citizen Yes No
(Proof of date of birth is required if not updated in the Customer ID)
Joint Applicant 1: _______________________________________________________
Joint Applicant 2: ________________________________________________________ Mobile Number: ______________________________________
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 Money Multiplier Deposit (Cumulative Only)
Fixed Deposit without Premature Closure Option (separate application form to be filled)
Period of Deposit: ____________________Years ___________Months _____________Days. Rate of Interest ______________________% per annum
Interest Payout option: Cumulative (interest will be paid on maturity) Quarterly Monthly (Rate of interest will be discounted)

Deposit Amount: Rs ________________________(Rupees __________________________________________________________________________________)

PAN Number of the first applicant_____________________________________ ( Mandatory for deposit amount of Rs 50,000/- & above & Tax Saver FD)
Mode of operation: Singly Jointly Either or Survivor Former or Survivor Later of Survivor Other
Note: In case applicant proposes to open a Joint FD account and fails to specify the mode of operation, the same shall be open
Payment Details
Payment mode and details of deposit: Cheque Cash Standing / Debit Instruction

Cash Details Cheque Details

Deno X Pieces Rs.
______X ______ ______________________________ Bank Name: ____________________________________________________
______X ______ ______________________________ Branch : ______________________________________________________
______X ______ ______________________________ Cheque No.:______________________________________________________
Total _________ Rs. ______________________________ Amount : ______________________________________________________
Debit Instruction / Standing Instruction:
Fixed Deposit: I/We authorize ICICI Bank to debit Rs._______________________ from account no _________________________ 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
Issue DD/PO in ___________________________________________(Name)
OR
and payable at _____________________________________________(City)
Auto Close my Fixed Deposit on the date of maturity (Tick any one
Transfer fund through NEFT to my account no._____________________ option below)
With ______________________________________________________Bank Credit to my ICICI Bank account no:___________________________
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.)
Receipt Option
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)
OR for physical copy please select Issue me/us physical Fixed Deposit Receipt
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 is created shall also
be applicable to such FD I /We wish to appoint a new nominee for the deposit I/We do not wish to appoint a new nominee for the deposit.
Customer Copy
Date: ___________________________ Account No. /Customer ID: ___________________________ 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 Money Multiplier Deposit (Cumulative Only)
Applicant Name: ___________________________________ Joint Applicants: ________________________________________________________________
Amount of deposit (In figures): _______________________________Period of Deposit: _____Years ___Months ______Days. Rate of Interest _____% pa
Interest Payout option: Cumulative Quarterly Monthly (Rate will be discounted) Maturity Instruction: Auto Renewal Auto Closure.
Separate Form 15G/H has to be submitted every financial year to claim exemption from TDS as exemption will be available from the date of
receipt of Form 15G/H till the end of the financial year.
 Form DA1 (To be filled in only if a new nominee is to be appointed for the Deposit)
I/We_______________________________________________(names(s) & address(es) of the depositor(s)) nominate __________________________________
as the nominee for this FD/RD- to whom in the event of my/our death the amount of the deposit in the FD/RD account, particulars whereof are
given below may be returned by ICICI Bank Limited, ________________________________________________________________________.
* As the nominee is a minor on this date, I/we appoint the guardian (details provided here under) to receive of the deposit on behalf of the

Nominee Name _________________________________________ Date of Birth_____________ Relationship with Applicant____________________________

Nominee Address______________________________________________________________________________________________________________________
City__________________________________________State_____________________________________________________________Pincode________________
_________
Guardian Address____________________________________________________________________________________________________
City__________________________________________State_____________________________________________________________Pincode________________
Signature (s) / + Thumb impression(s) of all the applicant (s)
__________________________________ __________________________________ ___________________________________
Applicant Signature Joint Applicant 1 Signature Joint Applicant 2 Signature
Name of Witness 1 _______________________________________ Name of Witness 1 _______________________________________________
Signature ________ ______________________________________ Signature ________________________________________________________
Address ________ _______________________________________ Address _________________________________________________________
Place _______________ ______ Date________________ Place __________________________ Date ___________________
Where the deposit is a minor, the nomination shall be signed by a person lawfully entitled to act on behalf of the minor. +Thumb impression shall
be attested by 2 witnesses. If witnessed by an employee of ICICI Bank, provide employee number and office address along with the official stamp.
Nomination can be made in favour of only one individual. Nomination name to be printed on Fixed Deposit Advice or Receipt Yes No
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).
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.

or Survivor' or
(Please note that this clause is valid only when all the joint account
holders sign the application- cum-deposit slip)
y the deposit/s before the maturity of the deposit/s in case such a request is received in
accordance with the operating instructions of the respective deposit/s, along with relevant documents as may be specified by the Bank from time
to time. The same would be applicable even in the event of death of any of the joint depositors prior to maturity of the deposit. Any such
t limited to the
nominee / legal heirs of the depositors or anyone claiming under them.
Terms and Conditions
a) I/We agree that the proceeds of the deposit will be paid as per existing bank
date unless the Deposit is Auto Renewed. Premature withdrawal of deposit will be subject to penal rates as per bank For penal
rates, please contact our branch executives or visit our website: www.icicibank.com
b) 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.
c) 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 operation of the account. However, Fixed
Deposit for Non individuals, Tax Saver Fixed Deposit, Recurring Deposit, auto renewal option shall NOT be available.
d) 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.
e) 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.
f) I/We understand at the discretion of the Bank, loan against the Deposit may be given to the depositors, 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 denied on the date of opening of the recurring deposit account. Subsequent installment shall be
denied on the selected day of the 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 rates as may be specified by ICICI bank for the period of delay.
__________________________________ __________________________________ ___________________________________
Applicant Signature Joint Applicant 1 Signature Joint Applicant 2 Signature
To be filled in by Bank Officials
Value Date: __________________________Transaction ID: _______________________________FD /RD Account Number: ____________________________
Transaction Entered by: ______________________Transaction Verified by: _______________ RD Standing Instruction no: ______________________
Employee Number of sourcing staff: _________________ Branch SOL ID: ___________________Initial of Branch Official: ______________________
Annexures attached: Form 15 G/H Tax Exemption Certificate Form 60 / PAN
Nomination Acknowledgment
We acknowledge nomination made by you in favor of Mr./Ms./Mrs. _____________________________________ aged __________ in respect
of your Fixed/ Recurring Deposit Account Number ____________________________ on the basis of Form DA1 dated ___________________.
We acknowledge nomination carried forward by you from your Operative Account number: _______________________________________
Branch Official's Signature: _______________________________ Bank Seal
Notes:
1. Tax Saver Fixed Deposit: Tenure is five years. Premature withdrawal is not allowed. No Loan or lien permitted.
2. NEFT: Funds transferred through NEFT are credited on next working day. Please note that the Beneficiary A/c Number should not be a NRE a/c.
3. Premature withdrawal of Deposit will be subject to penal rates as per bank's policies. For penal rates, please contact our branch executives or visit our website:
www.icicibank.com.