Application Form Number: US0001274112

Product Type: Personal Loan

Personal Loan

iLENS ID 300812363
Balance Transfer Flag No

Type of Interest Fixed

Loan Purpose Other Personal Need

Pre-Approved Offer No

DID (Disbursement intended

NA
date)

Loan 1 Loan 2 Loan 3

Type of Facility Personal Loan NA NA

Financial Institution NA - -

PA Offer Amount NA - -

PA Offer Tenure NA - -

Loan Amount requested RS 15,00,000 /- NA NA

Loan Tenure 72 Months NA NA

Original loan amount

NA NA NA
sanctioned

Seasoning of Loan NA NA NA

Base loan account number NA - -

APPLICANT DETAILS

Personal Details

Name Shubham Singh

Mother's Name guddi devi

Father's Name rakesh singh

Spouse Name NA

Gender Male

Date of Birth 15/08/1997

PAN MMXPS9257A

PAN Linked with Aadhar Yes

Aadhaar Number XXXXXXXX9084

Marital Status Single

 Application Form Number: US0001274112
Product Type: Personal Loan

Number of Dependents NA

Person with disabilities NO

Category General

Religion Hindu

Residency Status RI

Current Residence NA

Qualification Graduate

Net monthly Income 53216

Gross Annual Income 610000

Mobile No +91 9772172702

Email ID [email protected]

Current/Communication Address

village mainpura block udaipurwati, c/o raj kumari devi, Jhunjhunu, Jhunjhunu,
Address
Rajasthan, 333053

Permanent / Registered Address

Address village bilooni dholpur, s/o rakesh singh, Jaipur, Dholpur, Rajasthan, 328030

Occupation/Business Details

A. Salaried / Self Employed Salaried

Total Experience/ No of
48 Months
years in business

Entity/Employer Name state goverment

Employer Type Government

Department/Division ejucation

Designation Teacher

Employee No RJJJ202223017952
vill mainpura block udaipurwati, govt upper primary school gadla khurd, Jhunjhunu,
Office Address
Jhunjhunu, Rajasthan, 333053
Contact Details +91 9772172702

Email ID NA

Banking Details
 Application Form Number: US0001274112
Product Type: Personal Loan

Do you have an ICICI Bank No

Account?
Bank Name PNB

Account Type Salary Account

Account Number 1942001700341615

Biometric Kyc Details

Address NA
Date Selected for Visit NA

Time Slot Selected for Visit NA

Consent For ICICI Bank

CONSENT FOR DATA SHARING

A) I/ We, unconditionally and irrevocably, authorise (i) the Bank, (ii) its group companies, (iii) its agents, (iv) its
representatives and/or (v) third parties engaged by the Bank, to: collect, access, store, use, share, exchange and process
all information and records (including personal information) received (from me and/or external sources), for (i) designing,
improving and providing the product and services, (ii) analysis & verification, and/or (iii) credit assessment

B) We authorize the Bank/ its group companies/ agents/ representatives to verify my/ our information with credit bureaus,
agencies, auditors, statutory/regulatory authorities, service providers and such other third parties as it/ they deem
necessary and disclose, exchange, share with the RBI or any other authority including but not limited to credit bureaus,
credit information companies, or any other third party all the information and details relating to the name, my/ our credit
information including payment history, financial assistance extended/ to be extended to me/us, my/ our existing loans
and/ or repayment history and such other information as may be deemed necessary.

C) MARKETING CONSENT

The Bank would like to use your personal details in the application form/registration form from time to time to send you
marketing information to inform you about product, services or promotional offers that are offered by the Bank on its own
and in collaboration or through tie-ups with partners/third parties. By opting into the following methods of communication,
you confirm that Bank may contact you for these purposes in one or more of the following ways:

None of the above

The Bank would like to share your personal details in the application form/registration form with its group entities/partners
of the Bank so that group entities/partners of the Bank may from time to time sent you marketing information to inform you
about the products, services or promotional offers that are offered by the group entities/partners in collaboration with the
Bank. By giving your preference below you either allow or disallow the Bank to share your personal details in the
application form/registration page:

No data sharing with Group companies or Partners

You can proactively opt-out of this any time or update your preferences by visiting our branches or by calling us, please
also see our privacy notice for more information in relation to how we collect and use your personal information for EU
data subjects: https://www.icicibank.com/nri- banking/RHStemp/privacy-notice-eu-users.page/for domestic customers:
https://www.icicibank.com/privacy.page

Cross Sell
 Application Form Number: US0001274112
Product Type: Personal Loan

I the Applicant/Co-Applicant hereby give my consent that I/we are interested to open an ICICI Bank Saving*/Current
Account (” SA” /”CA”), basis the information and KYC documents furnished by me/the co-applicant (”Applicant/s”) in ths
ICICI Bank home loan application form. I/We further give my / our express consent to ICICI Bank and its authorized
personnel to contact me /us in the person/phone/SMS/ e-mail with regards to opening of the SA/CA with ICICI Bank.

NA

PEP Declaration

Are you (or any of the Beneficial Owners) a Politically Exposed Person (PEP) or are you (or any of the Beneficial Owners)
a family member or close associates of Politically Exposed Person (PEP)

No

1. The term family member include close family members such as spouse, children, parents and siblings and may also
include other blood relatives and relatives by marriage.

2. The term close associates in context of PEP include close business colleagues and personal advisors/consultants to
the PEP as well as persons who obviously benefit significantly from being close to such a person

GENERAL DETAILS

Property Details(Collateral)

Property Identified NA
Project Name NA

APF No NA

Address 1 NA

Address 2 NA

City NA

District NA

Pin-Code NA

State NA

Property Status NA

Overdraft Product Details

Has the Customer opted for

No
OD Facility product ?
Current / Saving Account
NA
Number

Purpose of OD Facility NA

Please Specify NA
 Application Form Number: US0001274112
Product Type: Personal Loan

Gst Related Details

Are you registered for GST? No

GST Applicable Customer No

GSTIN NA

Declarations

I/ We hereby declare and confirm that:

1. All the information (including any indebtedness and statutory dues related information), documents and details
provided by me/us in the application form (whether submitted electronically or physically) are true, complete and up-
to- date in all respects and no material information has been withheld or concealed by me/us. I /We undertake to
keep ICICI Bank (“Bank”) informed of any changes in any of the information/ details provided by me/ us.
2. I/ We am/ are aware that loan (if sanctioned) shall be governed and subject to the terms and conditions as
contained in the loan agreement and other transaction documents.
3. The Bank has the sole discretion to accept or reject my/ our application as per its internal policies and the
applicable laws. I/We agree that the Bank shall not be held responsible for such rejection and/ or any costs, losses
or other consequences caused because of such rejection.
4. I/We authorize Bank, its group companies, representatives, agents and any third parties appointed by the Bank to
conduct enquires and verification in relation to the application form as it/ they may consider necessary.
5. No insolvency proceedings and/ or any criminal proceedings have been initiated and/ or are impending against me/
us and that I/ We have never been adjudicated insolvent by any court or other authority.
6. I/We consent for receiving information from the central Know Your Customer (KYC) registry through available
modes of communications including SMS/ WhatsApp/ email on my/ our registered number/ email address.
7. I hereby declare that I authorize ICICI Bank to download/fetch my CKYCRR record for the purpose of processing of
loan application and/or updating the CKYCRR record reference number in Bank’s records or any other related
purposes
8. No payment(s) either in cash or otherwise in any other manner has/have been made by me/ us to the executive
collecting this application form or to any other representative of the Bank.
9. Except to the extent disclosed to the Bank, no Chairman / Managing Director or director or a relative/near relation,
as specified by RBI, of a Chairman / Managing Director or director of a banking company (including the Bank and
its subsidiaries) or mutual funds/venture capital funds or a relative/near relation, as specified by RBI, of a senior
officer of the Bank, as specified by RBI, is: a partner of its concern, or a trustee, member, director, manager,
employee of its concern, or of its subsidiary, or its holding company, or a guarantor on its behalf, or holds
substantial interest in its concern or its subsidiary or holding company.

For the purpose of this clause the terms “relative”, “near relation” & “senior officer” shall have the same meaning
ascribed to them under the RBI master circular on Loans and Advances dated July 1, 2015, para 2.2.1.8 and shall
include any amendments made thereto.

10. The Bank and its group companies reserve the right to retain the application form and all other documents
including photographs in accordance with the relevant internal policies and the applicable laws.
11. I/We authorize the Bank to share the application form with its affiliates/group companies for appraising the loan and
such group companies/affiliates may contact me/us for offering their loan facility required by me/us. Approval of the
loan application and disbursements thereunder shall be made by such affiliates/group companies, at its sole
discretion.
11.
Application Form Number: US0001274112
Product Type: Personal Loan

12. I/ We, unconditionally and irrevocably, authorise (i) the Bank, (ii) its group companies, (iii) its agents, and/or (iv) its
representatives, to: collect, access, store, use, share, exchange and process all information and records (including
personal information) received (from me and/or external sources), for (i) and in connection with the loan, (ii)
analysis, (iii) credit scoring, (iv) carrying out marketing and promotional activities; and/or (v) making offers of
various financial or other products and/or services through any mode (including without limitation through
telephone calls/SMSs/e-mails/ WhatsApp) to me/us.
13. I/ We further agree and confirm that the any document(s) submitted by me/ us to the Bank in electronic form shall
only be submitted through my/ our registered email address and any such document(s) sent by me/ us through my/
our registered email address can be relied upon by the Bank for considering my/ our application.
14. I/We understand that electronic/telephonic/digital channels are not secured mode of transmission and may be
subject to tampering and unauthorized access, fraudulently or mistakenly written, altered or sent, not be received in
whole or in part by the intended recipient, may reach you/us in a jumbled state or in a manner or shape that it may
be misunderstood. I/We hereby agree to bear all risks and responsibility with respect to the Bank acting on the
basis of such information/ document(s) furnished over aforesaid medium.
15. Consent to Aadhaar based authentication/ verification: I/ We voluntarily submit my/ our Aadhaar details to the Bank
for the purpose of establishing my/ our identity/address proof to open account /process instructions/ facilitating
affixation of Aadhaar based digital signature in my/ our name or as an authorised signatory. The purpose of
collecting Aadhar has been explained to me/ us in local language. Upon authentication, UIDAI may share with the
Bank information in nature of my/ our demographic information (including photograph) which the Bank may use for
the aforesaid purpose. I/ We consent for sharing my/our Aadhaar detail with UIDAI, NPCI, regulatory or statutory
authorities as required under applicable laws. I/We have been informed that my/our biometric information will not
be stored by the Bank.
16. I/We acknowledge that the request for cancellation of the loan must be given before first instalment and that any
such request, if made after the disbursement of the first instalment, shall be treated as a request for loan
foreclosure.
17. The GSTIN number provided by me/ us can be used by the Bank for the purposes of charging GST and reporting
of transactions on the GSTN portal and for other related aspects as may be required under the applicable laws.
18. If after repayment of the loan, the amount lying in the loan account maintained by the Bank is less than or equal to
Re.1, the Bank reserves the right to appropriate such amount and utilize the same in the manner it deems fit.
19. I/ We authorize the Bank/ its group companies/ agents/ representatives to verify my/ our information with credit
bureaus, agencies, auditors, RBI, other statutory authority, service providers and such other third parties as it/ they
deem necessary and disclose, exchange, share with the RBI or any other authority including but not limited to
credit bureaus, credit information companies, or any other third party all the information and details relating to the
name, my/ our credit information including payment history, financial assistance extended/ to be extended to me
/us, my/ our existing loans and/ or repayment history and such other information as may be deemed necessary.
20. That I/We are aware that the loans (if sanctioned) shall also be governed by certain terms and conditions, including
terms as available on the website www.icicibank.com and other transaction documents. I/We have read,
understood and agreed to abide and comply with the same, including changes made from time to time.

19 A. For electronically submitted application form – I/We confirm that by submitting this application form and
applying for the product through Bank’s website www.icicibank.com (“ICICI Bank Portal”), and clicking on ‘Accept’/’
Agree’/‘Agree and Proceed’ icon/button and/or by submitting one-time password received on my/our registered
mobile number and/or by affixing electronic signature (e-sign) or digital signature certificate, I/We have read,
understood and agreed to abide and comply with the same, including changes made from time to time.

Terms specific to Credit Card –

• For cash withdrawals interest will be charged from the day of transaction and no free credit period will be
provided.

• The card application shall continue to be valid for any replacement card provided at the time of closure/renewal.

21.
 Application Form Number: US0001274112
Product Type: Personal Loan

21. I/ We understand that any reference to terms such as preliminary application form, preliminary credit appraisal
form, appraisal application form, preliminary credit facility application form, facility application form and/or any other
application form in any of the transaction documents, as the context may require, shall refer to this application
form.
22. I hereby represent, warrant and confirm that the aforesaid purpose is a valid purpose and is not speculative or
illegal in any manner. I also declare that funds under the facility will not be used towards purchase of gold in any
form, including primary gold, gold bullion, gold jewellery, gold coins, units of gold Exchange Traded Funds (ETF)
and units of gold Mutual Funds. I further agree, confirm and undertake that the purpose of use of funds under the
Loan shall not be changed in any manner during the tenor of the Loan; or that such change in purpose shall take
place only with the prior written permission of ICICI Bank. I agree that any breach or default in complying with all or
any of the aforesaid undertaking(s) will constitute an event of default under the facility document.
23. In compliance with the rule 9B of the Prevention of Money Laundering (Maintenance of Records) Rules, you are
required to intimate us if there is any change in your KYC details along with updated documents (i.e. address,
contact details, profile, etc.) within a period of 30 days from the date the change was made. Once you intimate us,
we will make necessary changes in our records. Any update can be intimated to the Bank as per the consent
provided in application form.
24. Registration with the Ministry of MSME, Government of India, helps microenterprises by providing access to
various government services including improved credit facility. The Government has approved a special process
through which banks can help their microenterprise customers to obtain the Udyam Registration Number by
sharing their basic information (including Aadhaar) with the Udyam Assist platform (www.udyamassist.gov.in) I
provide consent to ICICI Bank to use my information for the Udyam Registration process.
25. I/We understand that the use of the Business Card is meant only for the official expenses as shall be approved by
the Company/ Firm where I/We am employed (“Company/Firm”) from time to time and not for my/our personal
expenses
26. I/We declare that I/we have read, understood and hereby agree to abide by the application form, Most Important
Terms and Conditions and the terms/ conditions governing the Business Card facility of ICICI Bank Limited as
given on the website of ICICI Bank. I/We understand that access to any changes/updation in the terms and
conditions applicable to the Business Card would be available on the website of ICICI Bank Limited only i.e. at
www.icicibank.com.
27. I/We declare and undertake that the Business Card issued to me/us, if used overseas, shall be utilized strictly in
accordance with the relevant exchange control regulations issued and as amended by the Reserve Bank of India
(RBI) from time to time. In the event I/we exceed my/our entitlements as per the exchange control guidelines of
Reserve Bank of India (RBI), I/we undertake to bring the same immediately to the notice of ICICI Bank Limited / its
group companies in writing. Further, I/we also agree and understand that if I/we are required to get my/our
passport endorsed for any charges incurred by me/us as stipulated by RBI, the onus of getting my/our passport
endorsed shall lie entirely on me/us. In the event of any failure by me/us to comply with the prevailing exchange
control guidelines issued by RBI, I/we shall be liable for any action under the Foreign Exchange Management Act,
1999, as amended and be debarred from the Business Card facility either at ICICI Bank Limited / its Group
Companies instance or by RBI.
28. The Company/Firm agrees that the Business Card facility is provided by ICICI Bank Limited at the request of the
Company/ Firm with joint and several liability of Company/ Firm and the Card-holder to pay the total outstanding
amount to ICICI Bank Limited without any delay and as per the Terms and Conditions governing the Business Card
facility of ICICI Bank Limited.
29. Online Dispute Resolution (ODR) : Any claim or dispute whatsoever (whether in contract, tort or otherwise) arising
out of or in connection under the terms of facility, including any question regarding its construction, meaning,
existence, validity, breach, recall, recovery or termination, shall be resolved and settled by mediation or conciliation
(if the Borrower(s) and ICICI Bank agree to such mediation or conciliation), administered in accordance with the
applicable mediation or conciliation rules of an independent online dispute resolution institution listed on ICICI Bank
Limited website (“ODR Institutions”). Any party may appoint any listed ODR Institutions to facilitate mediation or
conciliation. If one Party appoints an ODR institution before the other, the ODR institution appointed by the first
Party shall be binding on other party. If the Borrower(s) and ICICI Bank do not agree to mediation or conciliation ,
or if the mediation or conciliation fails to resolve the claim or dispute within the period stipulated in such rules or
within a period of 21 days from the date of notice of appointment of mediator or conciliator (whichever is earlier),
then the claim or dispute shall be taken forward for adjudication by arbitration in terms of the applicable rules of
 Application Form Number: US0001274112
Product Type: Personal Loan

said ODR Institution, and in accordance with the Arbitration and Conciliation Act, 1996, which shall be conducted
(including for recording of evidence or tendering of documents), concluded and administered online by ODR
Institution through its website/platform or mobile application. The arbitral tribunal shall consist of an independent
sole arbitrator appointed in accordance with the applicable arbitration rules of the ODR Institution. The seat of
arbitration proceedings shall be Mumbai. The law governing the arbitration proceedings shall be Indian law. The
procedural law of arbitration shall be rules of ODR Institution.

*The below mentioned charges are only applicable for Overdraft Facility.

Description Of Charges

Processing Fees 0.99% of limit amount st. min. of Rs.1999 and max. of Rs.2999

Late Payment Charges Rs. 500/-

Fee on Renewal of Overdraft facility Rs. 1,999/-

2% per annum (applicable monthly) on the amount outstanding in the

overdraft account, chargeable over and above the normal interest on the
Penal Interest Rate
Overdraft Facility. (The Penal Interest Rate shall be applicable in case
of bounce on the Overdraft Facility billing on the Savings Account.)

Note: GST and other govt. taxes, levies, etc. applicable as per the prevailing rate will be charged over and above these
charges. The above mentioned charges are non-refundable and are subject to change. For the latest charges, please get
in touch with ICICI Bank representative.

Date & Time : 23-12-2024 19:36:29