ICICI Bank Limited, CPC-Demat Services, Ground Floor, B-Wing, Autumn Estate, Chandivali Farm Road, Opp.

Mhada Colony, Chandivali, Andheri (East), Mumbai - 400072.

Date D D M M Y Y Y Y DP ID Client ID

I/We wish to register my/our e-mail ID and /or mobile number to subscribe for SMS Alerts in the above mentioned Demat account
number

* Note SMS alert facility is mandatory for Demat Account operated by Power of Attorney (POA) as per regulatory guidelines.
On registering your email address, the Demat statements & Annual statement will be by default sent via email.
On registering your mobile number, you will be receiving SMS alerts for your Demat transactions.

Sole/First Holder

Mobile No.

E-mail
*The mobile number belongs to Self Spouse Dependent Parent Dependent Children
*The email Id belongs to Self Spouse Dependent Parent Dependent Children

Second Holder

Mobile No.

E-mail
*The mobile number belongs to Self Spouse Dependent Parent Dependent Children
*The email Id belongs to Self Spouse Dependent Parent Dependent Children

Third Holder

Mobile No.

E-mail
*The mobile number belongs to Self Spouse Dependent Parent Dependent Children
*The email Id belongs to Self Spouse Dependent Parent Dependent Children
 I affirm, confirm and undertake that I have read and understood the Terms & Conditions for usage of the Internet Banking, Phone Banking and/or Mobile Banking service of ICICI Bank
Limited & I aware of Charges Applicable for the Mobile Banking Service, as set orth in www.icicibank.com & that I agree on my own behalf, or as the mandate holder on behalf of the
joint account holders, and will adhere to all the term/conditions of opening/applying/availing/maintaining/operating (as applicable) for usage of the Internet Banking. Phone Banking
and/or Mobile Banking service of ICICI Bank Limited as may be in force from time to time. I further authorize ICICI Bank Limited to debit my Account(s). I declare that all the particular
and information given in this application form (and all documents referred or provided therewith) are true, correct, complete and up-to-towards any charges for Mobile Banking
service. I declare that all the particular and information given in this application form (and all documents referred or provided therewith) are true, correct, complete and up-to-date in
all respects and I, other joint holders have not withheld any information. I understand that certain particulars given by me are required by the operational guidelines governing
banking companies. I agree and undertake to provide any further information that ICICI Bank Ltd./its Group Companies reserve the right to retain the application forms, and the
documents provided therewith, including photographs and will not return the same to me. I authorize ICICI Bank ltd./its Group Companies or their agent to make reference and
inquires which ICICI Bank Ltd./ Its Group Companies consider necessary in respect of or in relation to information in this application/further applications. I agree and hereby authorize
ICICI Bank Ltd/its Group Companies to exchange, share or part with all the information, date or documents relating to my/our application to other ICICI Group Companies/Banks/
Financial Institutions/Credit Bureaus/Agencies/Statutory Bodies/such other persons as ICICI Bank Ltd/its Group Companies may deem necessary or appropriate as may be required
for use or processing of the said information/date by such person/s or furnishing of the processed information/data/products thereof to other Banks/Financial Institutions/credit
providers/user registered with such persons and shall not hold ICICI Bank Ltd/its Group companies liable for use of this information. I agree and understand that I have to complete
further application for specific liability products/services from ICICI Bank Ltd./its Group Companies, as prescribed from time to time, and that such further applications shall be
regarded as an integral part of this application (and vice versa), and that unless otherwise disclosed in such further forms as prescribed, the particulars and information set forth
herein as well as documents referred or provided herewith are true, correct, complete and up-to-date in all respect. I agree and understand that such further applications will require
incorporation of the application form number, and/or such details ICICI Bank may prescribe, to facilitate data management. We, the joint applicants hereby confirm that we have
instructed and authorized the first applicants to view/access the information on the said account for and on behalf of all the undersigned and under our specific instructions as stated
in this letter. We hereby state that should we wish to revoke the above authorization, we shall duly issue a letter of revocation to ICICI Bank in this regard. We hereby agree that until
ten days after ICICI Bank receives such letter revoking the above mandate, the authorization as afore stated shall hold good.

1. The Client(s) is/are aware that he/she will not receive the transaction statements in paper form.
2. The Client(s) will take all the necessary steps to ensure confidentiality and secrecy of the login name and password of the internet/email account.
3. The Client(s) is/are aware that the transaction statement may be accessed by other entities in case the confidentiality/secrecy of the login name and password is compromised.
4. In case transaction statements are sent by email, the Client(s) shall immediately inform the ICICI Bank Ltd about change in email address, if any.
5. ICICI Bank Ltd and Client(s) shall have the right to terminate such service provide a written notice is given atleast 10 days in advance to the other party.

SIGNATURE OF SOLE/FIRST HOLDER SIGNATURE OF SECOND HOLDER SIGNATURE OF THIRD HOLDER

Date: D D M M Y Y Y Y SDO Code SDO Name

Signature of Bank Official Bank Branch Seal

1 Application should be signed by all account holder.

2 If category of Demat Account is HUF, then HUF Stamp is required on application.

3 E-mail Id & Mobile Number should be legible.

4 Check the category of Demat Account. If Account is NRI category, mobile alert facilities cannot be provided.

We acknowledge the receipt of Customer Modification Instruction for the below mentioned account:

DP ID Client ID

Received by

Bank Official Signature

Branch SR No

Date D D M M Y Y Y Y

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