APPLICATION FOR REGISTRATION OF BANK ACCOUNTS FOR PAYMENT GATEWAY FACILITY

(Please read the instructions overleaf)

To, Date: ______________________

ICICI Securities Limited.
Shree Sawan Knowledge Park,
Plot No - D 507, T.T.C Ind Area, M.I.D.C
Turbhe,Opp. Juinagar Railway Station,
Navi Mumbai – 400705.

Dear Sir/ Madam,

I wish to register my below mentioned bank account(s) for using Payment Gateway facility on
www.icicidirect.com. Kindly map the same to my Trading/ Investment Account. Details of my account are
mentioned below:

Name of the Applicant : _____________________________________________________

Trading / Investment Account Number : _____________________________________________________

Details of my Bank Account(s) to be mapped to my abovementioned Trading/ Investment Account(cancel

whichever is not applicable).
Bank Account Details (1) (2) (3)
Bank Name

Account Number

Name as appears on
bank a/c
A/c Type ( tick) Saving/ Current Saving/ Current Saving/ Current
A/c category (tick) Single/ Joint holder Single/ Joint holder Single/ Joint holder

Name of the Joint

Holders
Bank Branch
City
IFSC Code
MICR Code
(Kindly find enclosed a self attested copy of my Bank Statement/ Pass Book of the abovementioned Bank
account(s) along with a cancelled cheque)

I wish to change my default account _________________________________________ and wish to register

account number ___________________________________________as my Default account.

Thanking you
Yours sincerely,

x
_________________________________
Signature of First Applicant
 AUTHORISATION BY THE JOINT HOLDERS IN THE BANK ACCOUNT

I/We refer to the application made by (first holder of the account)_______________________________

vide letter dated ___________________ for change of default account for the Investment account.

I/we understand and agree that Investment account offered by ICICI Securities Ltd (herein after
referred as I-Sec) enables (name of the first holder)_________________________________________
to make payments for various services/ products by placing instructions electronically vide the
Internet through the registered bank account(s).

I/ We authorize I-Sec to consider account no.________________________________as default account.

I/we understand and agree that funds payout for all successful transactions in the aforementioned
Investment account will be credited to the above mentioned default account.

I/We hereby ratify and confirm and agree to ratify and confirm all that ICICI Securities or any of its
officer or officers shall do or cause to be done concerning the above.

Account No 1 : _____________________________

x
____________________________ x______________________________
Signature of Joint holder 1 Signature of Joint holder 2

____________________________ ______________________________
Name of Joint holder 1 Name of Joint holder 2

Account No 2: ______________________________

x____________________________ x
_______________________________
Signature of Joint holder 1 Signature of Joint holder 2

__________________________ ______________________________
Name of Joint holder 1 Name of Joint holder 2

Account No 3: _____________________________

x x
___________________________ ______________________________
Signature of Joint holder 1 Signature of Joint Holder 2

____________________________ ______________________________
Name of Joint holder 1 Name of Joint holder 2

Please note : To be signed by joint holders of all bank accounts mapped to the Investment account.
 INSTRUCTIONS

Please read the below instructions carefully. Mapping of your bank account(s) for Payment
Gateway Facility is subject to the fulfillment of the conditions mentioned below.

1. Only such Bank account(s) in which you are first holder can be mapped to your Trading/Investment
account for Payment Gateway Facility.

2. Accounts with designated banks only can be registered for the Payment Gateway facility. Refer
Annexure for the list of Banks, available presently for Payment Gateway facility on
www.icicidirect.com.

3. Please ensure to indicate your Default account, if not already done. All payouts for successful
transactions will be credited to the Default account only.

4. If you have requested to change your Default account, till such request is satisfactorily processed,
the payout amount due to you,will be credited to your existing default account as appearing in the
payee records.

5. ICICI Bank account, if already linked to your Trading/Investment account, will automatically become
your default account.

6. If your default account is non functional/closed/inactive at any stage, ensure to inform ICICI
Securities Ltd of the same on an immediate basis and apply for change of default account.

7. Submit the below list of documents with this form to avail the Payment Gateway facility, your name
should be present on any one of below documents :
a) Cancelled Cheque of the Bank account which you wish to map to your account.
b) A self attested copy of your Bank Statement/ Pass Book not more than 3 months old indicating
names of all the joint holder(s) of account given for mapping.

8. Please read the FAQ's posted on site www.icicidirect.com to know more.