Page 1 of 7

MHW1/181D/1-1/WBF-M/03-12

067401004478??BYKA1206 516193

MR.ADARSH MISHRA Your Base Branch: ICICI BANK LTD., GNV & RV
INSIGNIA,,IMAGE GARDEN ROAD, SILICON VALLEY,
160, ASHOK NAGAR, MADHAPUR,500081
THANA,
UTTAR PRADESH- INDIA - 208017 Visit www.icicibank.com
Dial your Bank B479

Did you know? It's mandatory to be KYC compliant as per RBI guidelines. If you have not submitted your KYC documents, please visit the nearest
branch or contact your Relationship Manager to complete KYC details for your Account.

Summary of Accounts held under Cust ID: 438478349 as on February 04, 2025
ACCOUNT DETAILS - INR
ACCOUNT TYPE A/c BALANCE(I) FIXED DEPOSITS (LINKED) BAL.(II) TOTAL BALANCE(I+II) NOMINATION
Savings A/c 411201500743 8.25 0.00 8.25 Registered
TOTAL 8.25 0.00 8.25

Statement of Transactions in Savings Account Number: 411201500743 in INR for the period January 04, 2025 - February 04, 2025

DATE MODE** PARTICULARS DEPOSITS WITHDRAWALS BALANCE

04-01-2025 B/F
UPI/bunny701316@oki/UPI/ANDHRA
05-01-2025 PRAGATHI/468353970011/ICId023ce889a4f4b5cbf2 2,200.00 2,232.24
32.24
eb47d30a3575a
UPI/6303185230shesh/Payment from Ph/ANDHRA
08-01-2025 PRAGATHI/603968368035/IBL06870f43b9b143508e 2,100.00 132.24
26439fbb37c50e
UPI/6303185230lav@a/Payment from Ph/State Bank
11-01-2025 OfI/832501383434/AXL4cfa2a0f22f740d39ef2aea362 70,000.00 70,132.24
3b0b54
UPI/7848839517@ybl/Payment from Ph/State Bank
Of
13-01-2025 I/138600035406/YBLddaa58481ba347a79c242e1f7f6 30,000.00 1,00,132.24
bc2e7
UPI/guriviehs@axl/Payment from Ph/ICICI
13-01-2025 Bank/893893267466/IBL0509a6df8cb14ed6a943e2b 50,000.00 50,132.24
0ee572970/
UPI/guriviehs@axl/Payment from Ph/ICICI
14-01-2025 Bank/290540710318/IBL6623125adfcb402b9604513f 50,118.06 14.18
64f7b426/
MMT/IMPS/432421883042/NA/SRILAKSHMI/Union
19-01-2025 MOBILE BANKING Bank OfI 1,00,000.00 1,00,014.18
UPI/BHARATPE9072388/Payment from
19-01-2025 Ph/YesBank_Yespay/573928807257/IBL93a9dddbd8 50.00 99,964.18
474462bc200fd43fc8cafa/
UPI/7036521939@ibl/Payment from Ph/BANK OF
19-01-2025 BARODA/475978459017/IBLea5198f0c6024ff5ac857 50.00 1,00,014.18
14235aa9db7
UPI/paytmqr1j0onzs9/Payment from Ph/Yes Bank
19-01-2025 Ltd/435643945252/IBL8cd3be18243f4d05b1e6c37e9 50.00 99,964.18
908b475/
UPI/6303185230shesh/Payment from Ph/ANDHRA
20-01-2025 PRAGATHI/956275134255/AXLc75f7d414ebe4a948 80.00 1,00,044.18
a01cbd84e2c53f3
UPI/6303185230shesh/Payment from Ph/ANDHRA
20-01-2025 PRAGATHI/023068240479/AXL478d079a6e164587b 20.00 1,00,064.18
ecb4a7c0254aec6
UPI/paytmqr5dsk8s@p/Payment from Ph/Yes Bank
20-01-2025 Ltd/142078588305/IBL9c7bb27da08d4f2497726ca5d 100.00 99,964.18
3c53e6c/
 Page 2 of 7

DATE MODE** PARTICULARS DEPOSITS WITHDRAWALS BALANCE

UPI/dvsubbareddy198/Payment from Ph/ANDHRA
PRAGATHI/717069641585/IBL4784fdb0917f4da7b9 90,000.00 9,964.18
e710f8bbf389f0
UPI/6303185230shesh/Payment from Ph/ANDHRA
20-01-2025 PRAGATHI/951969353650/AXLae0dbc0edb6f45358 36.00 10,000.18
20-01-2025 9dabab0071c9d08
UPI/dvsubbareddy198/Payment from Ph/ANDHRA
20-01-2025 PRAGATHI/721288998797/IBL156ad0d4046049c49e 5,000.00 5,000.18
c1b8506bbdb5c8
UPI/amazonpaybalanc/Request from Am/AXIS
20-01-2025 BANK/432543900170/APL032ff0d4fe804ecd96b5d4 50.00 4,950.18
e47a3c530c/
UPI/Q426450070@ybl/Payment from Ph/Yes Bank
20-01-2025 Ltd/361819195911/IBLfbae37ccb49d43699095dcd8 160.00 4,790.18
d446388e/
UPI/9553329867hdfc@/mvsr septsalary/HDFC
BANK
21-01-2025 LTD/364426232616/YBL1bd8903e6f81482c8d22732 20,000.00 24,790.18
57ff5ffb7
UPI/6304742723@ibl/Payment from Ph/Union Bank
of
21-01-2025 I/313084238333/IBLf30e4ebcb4584ca6923bf78d349 15,000.00 9,790.18
8cb0b/
UPI/dvsubbareddy198/Payment from Ph/ANDHRA
21-01-2025 PRAGATHI/929734836964/IBL7d5596db3c944de2a4 5,000.00 4,790.18
b36ad5e469417e
UPI/7842473105@ybl/Payment from Ph/AIRTEL
22-01-2025 PAYMENTS/166058349025/YBL80db9af6df4a4728b 4,500.00 9,290.18
ef10de2abf9bb58
UPI/paytm-urbancomp/Payment for Urb/Yes Bank
22-01-2025 Ltd/816770067639/PYTM41122803503762325529/ 368.00 8,922.18
UPI/urbancompany.rz/Payment for Urb/ICICI Bank
LTD
22-01-2025 /457619560149/IBL2a770d3dbf24457ebc571c7126a 227.00 8,695.18
590c3
UPI/6303185230lav@a/Payment from Ph/State Bank
22-01-2025 OfI/332125407220/AXL90203959978e42709c5357f7 600.00 9,295.18
e7204f01
UPI/6303185230lav@a/Payment from Ph/State Bank
24-01-2025 OfI/008124807901/AXLd89388b1c959441781e2a0fff 5.00 9,300.18
788434e
UPI/bunny701316@oki/UPI/ANDHRA
27-01-2025 PRAGATHI/469397309524/ICI2927dc9f165549b3b8a 200.00 9,500.18
9c993cb768332
UPI/paytmqr5xo8mh@p/Payment from Ph/Yes
Bank
29-11-2024 Ltd/046715720717/IBL2c7bed65a4fc478e89e503eb3 70.00 9,430.18
209cd51/
UPI/9966989828@axl/Payment from Ph/State Bank
Of
30-01-2025 I/521975026796/IBL05dc1329bb8440049f5e1254b92 500.00 8,930.18
681b3/
UPI/HYDMETROINAPP@y/Payment from Ph/Yes
Bank
01-02-2025 Ltd/977875460441/IBL49a6dbeae1c04414a1b031e0 35.00 8,895.18
d1a5c014/
UPI/9553329867hdfc@/mvsr Oct salary/HDFC
BANK
02-02-2025 LTD/493542840149/YBL86f98b7e000f41b4b62d15e 20,000.00 28,895.18
6d9336464
UPI/penubadiramaiah/Payment from Ph/State Bank
02-02-2025 OfI/517935072118/IBL9feef25edd7a45b8831d8d0b1 13,000.00 15,895.18
4114333
UPI/7989101320@ibl/Payment from Ph/ANDHRA
04-02-2025 PRAGATHI/335859292931/IBLa10ac851028e463fab 1,000.00 16,895.18
2a4fdc8540f7eb
 Page 7 of 7

MRS.JYOTI DEVI

Account Related Other Information

ACCOUNT TYPE ACCOUNT NUMBER MICR CODE IFSC CODE NAME OF NOMINEE
Savings 204701002283 50348764 ICIC0000558 -

Nominee name is displayed only on specific consent of customer.

Sincerely,

Team ICICI Bank.

This is a system-generated statement. Hence, it does not require any signature.

Legends for transactions in your account statement

VAT/MAT/NFS - Cash Withdrawal at other bank's ATM INF - Internet funds transfer in Linked accounts
EBA - Transaction at ICICIDirect BIL - Internet bill payment or Funds transfer to third party
VPS/IPS - Debit card transaction TOP - Mobile Recharge
RTGS - Real Time Gross Settlement (Instant Transfer of Rs 2 Lakh and up to Rs 10 Lakh) NEFT - National Electronic Fund Transfer (Up to Rs 10 Lakh)
• **Mode is available only for transaction done after August 6, 2013.

• As per prevailing guidelines of the Income tax Act, 1961 if a valid PAN is not provided by the •In absence of valid PAN, Form 15G / 15H shall not be treated as valid and tax will be deducted.
Customer then tax shall be deducted at the prevailing rate or 20%, whichever is higher. •In case your PAN is not updated in our record, please visit the nearest branch and provide a copy
•As per guidelines issued by CBDT on May 13, 2011, Form 16A (TDS Certificates) will be generated of the PAN card along with the original PAN card for verification.
through the Income tax website for which the PAN of the customer needs to be necessarily updated •The address of the customer in Form 16A will be the last updated address in the data base of the
in Bank's record. Income tax department.

REGD ADDRESS: “LANDMARK”, RACE COURSE CIRCLE, VADODARA - 390 007, INDIA www.icicibank.com
This is an authenticated intimation/statement. Category of service: Banking & Financial Services.
Customers are requested to immediately notify the Bank of any discrepancy in the statement Registration No. MIV/ST/Bank & Finc/4.
MHW1-WBG-M-05-Mar-12/148405000053 - 525322040/207/207 - Utility - 1 of 1 PAN Based STC No. AAACI1195HSST001.