US NRI / NON US 6
US NRI 6 / NON US I have registered myself on ICICIdirect.com website for opening an ICICIdirect.com account including bank and demat accounts. The USER ID and password for this account has been selected by me at the time of registration and I undertake to keep the password confidential. I am aware that fresh password would be issued to me after the above account is opened and I would be able to access my account with the fresh password only. (It should be 6, 8 characters) (As registered on site or preferred user ID) SSN / USA: : Employment Visa Work Permit Student Visa Single Entry Visa Residence Permit Single Entry-visa Permitting Employment Others Please tick applicable Politically Exposed Person Related a politically exposed person I am not Politically Exposed Person neither I am Related to a politically exposed person Are you a US Person Yes No Please specify your country of Birth India Others please specify If, you are a US person Please mention USA Tax payer Identification number or equivalent: House No.: Street No.: Landmark: Street Name: Premise Name: Locality: Building Level 1/Floor House No.: Street No.: Landmark: Street Name: Premise Name: Locality: Building Level 1/Floor Permanent Indian Please submit copy of SSN card or any other documentary proof evidencing your TIN for verification purpose. *** To convert an existing Resident Savings bank account to NRO Account, kindly fill declaration on page 8. 49 6
# Your Occupation & Account Activity If self Employed, and if in Business, nature of Business Services If Professional, type of profession Engineer If Salaried, employed with Public Ltd. <1 Lac 1-5 lac 5-10 lac 10-25 lac >25 lacs Whether the applicant is interested in receiving Demat / Bank transactions Statement through e-mail Yes No (If YES, please provide your e-mail ID on page 1) 2
If client is dealing through the sub-broker / AP, provide the following details: Sub-broker s / AP Name: SEBI / AP Registration number: Registered office address: Ph:.... Fax:........ Website:.... Mode of receiving Statement of Account [Tick any one] Physical form Electronic Form [Read below note and ensure that email id is provided in KYC Application form] For receiving Statement of Account in electronic form: I. Client must ensure the confidentiality of the password of the email account. II. Client must promptly inform the Participant if the email address has changed. III. Client may opt to terminate this facility by giving 10 days prior notice. Similarly, Participant may also terminate this facility by giving 10 days prior notice. IV. Please Note that you would be receiving monthly e-statement on your registered e-mail ID & the physical statement would be sent annually to the communication address." Option for Issue of DIS booklet (please tick any one) Option 1 I/We wish to receive the Delivery Instruction Slip (DIS) booklet with account opening. Option 2 I/We do not wish to receive the DIS booklet with account opening. However, the DIS booklet should be issued to me/ us immediately on my/ our request at any later. Either Jointly & Any Frequency of Bank Statement (tick any one) Email - Monthly Free Physical-Quarterly (will be charged at applicable rates) Physical-Monthly (will be charged at applicable rates) Mode of Funding - Enclosed Cheque / DD no currency Amount drawn on Bank Name Remittance from Remitting Bank Bank Address and remittance reference no. of currency and amount Cash Deposit : Amount, Currency Please tick applicable Demat Co-holder A Please tick applicable Demat Co-holder B Gross Annual Income details <1 Lac 1-5 lac 5-10 lac 10-25 lac >25 lacs Gross Annual Income details <1 Lac 1-5 lac 5-10 lac 10-25 lac >25 lacs Occupation PEP / FATCA DETAILS Private Sector Service Public Sector Politically Exposed Person Related to a politically Exposed Person I am not Politically Exposed Person Government Service Business neither I am Related to a politically Exposed Person Are you a US Person Yes No Professional Agriculturist Retired Please specify your country of Birth Housewife Student Forex Dealer India Others please specify Others (Please Specify)... If, you are a US person Please mention USA Tax payer Identi cation number or equivalent: Occupation PEP / FATCA DETAILS Private Sector Service Public Sector Politically Exposed Person Related to a politically Exposed Person I am not Politically Exposed Person Government Service Business neither I am Related to a politically Exposed Person Are you a US Person Yes No Professional Agriculturist Retired Please specify your country of Birth Housewife Student Forex Dealer India Others please specify Others (Please Specify)... If, you are a US person Please mention USA Tax payer Identification number or equivalent: 3
Account Opening Form (For Individuals Only) Know Your Client (KYC) Co-Holder A Details in Demat if Relivent 4 Ver.26
Account Opening Form (For Individuals Only) Know Your Client (KYC) Co-Holder B Details in Demat if Relivent 5 Ver.26
SSN / USA No: Are you a US Person Yes No Please specify your country of Birth India Others please specify If, you are a US person Please mention USA Tax payer Identification number or equivalent: House No.: Street No.: Landmark: Street Name: Premise Name: Locality: Building Level 1/Floor House No.: Street No.: Landmark: Street Name: Premise Name: Locality: Building Level 1/Floor Permanent Indian <1 Lac 1-5 lac 5-10 lac 10-25 lac >25 lacs ` Source of Funds Investment 6
z 2 SSN / USA No: Are you a US Person Yes No Please specify your country of Birth India Others please specify If, you are a US person Please mention USA Tax payer Identification number or equivalent: House No.: Street No.: Landmark: Street Name: Premise Name: Locality: Building Level 1/Floor House No.: Street No.: Landmark: Street Name: Premise Name: Locality: Building Level 1/Floor Permanent Indian <1 Lac 1-5 lac 5-10 lac 10-25 lac >25 lacs ` Source of Funds Investment 7
I / We request you to close all active SIP in Investment Products and NPS Accounts held by me if any. I hereby authorize ICICI Bank to use any / all information, as contained in this application form, for the purpose of opening Money2India account on my behalf. I understand that Money2India account is a default service offered to me with NRI account and is currently being offered in U.S.A, Canada, United Kingdom, Singapore, Hong Kong, Sweden, Switzerland and U.A.E, and may be extended to other geographies as updated on ICICI Bank's website from time to time. 8
understood the contents of the Schedule of Charges, Rights & Obligation document, Risk Disclosure Document, Policies and Procedures, Guidance Note and Letter of Confirmation. I / We do hereby agree to be bound by such provisions as outlined in these documents. I / We have been also been informed that the standard set of documents has been displayed on www.icicidirect.com 4. The Rules and Regulations of the Depository Participant pertaining to an account which are in force now have been read by me / us and I have understood the same and agree to abide by and to be bound by the rules as are in force from time to time for such accounts. I / We acknowledge the receipt of copy of the document "Rights and Obligation of the Beneficial Owner and Depository Participant". 5. In case of any change in my U.S. Person status on a future date, I undertake to inform I Sec the same within 30 days. If agree that if I have confirmed that I am U.S. Person, my account would be considered as a U.S. Reportable Account and my account details, as required under Inter Governmental Agreement (IGA) signed by Indian Government, would be reported by I-Sec to the relevant tax authority identified in IGA. I / We further confirm having received, read and understood understood the contents of the Schedule of Charges, Rights & Obligation document, Risk Disclosure Document, Policies and Procedures, Guidance Note and Letter of Confirmation. I / We do hereby agree to be bound by such provisions as outlined in these documents. I / We have been also been informed that the standard set of documents has been displayed on www.icicidirect.com 4. The Rules and Regulations of the Depository Participant pertaining to an account which are in force now have been read by me / us and I have understood the same and agree to abide by and to be bound by the rules as are in force from time to time for such accounts. I / We acknowledge the receipt of copy of the document "Rights and Obligation of the Beneficial Owner and Depository Participant". 5. In case of any change in my U.S. Person status on a future date, I undertake to inform I Sec the same within 30 days. If agree that if I have confirmed that I am U.S. Person, my account would be considered as a U.S. Reportable Account and my account details, as required under Inter Governmental Agreement (IGA) signed by Indian Government, would be reported by I-Sec to the relevant tax authority identified in IGA. I / We further confirm having received, read and understood understood the contents of the Schedule of Charges, Rights & Obligation document, Risk Disclosure Document, Policies and Procedures, Guidance Note and Letter of Confirmation. I / We do hereby agree to be bound by such provisions as outlined in these documents. I / We have been also been informed that the standard set of documents has been displayed on www.icicidirect.com 4. The Rules and Regulations of the Depository Participant pertaining to an account which are in force now have been read by me / us and I have understood the same and agree to abide by and to be bound by the rules as are in force from time to time for such accounts. I / We acknowledge the receipt of copy of the document "Rights and Obligation of the Beneficial Owner and Depository Participant". 5. In case of any change in my U.S. Person status on a future date, I undertake to inform I Sec the same within 30 days. If agree that if I have confirmed that I am U.S. Person, my account would be considered as a U.S. Reportable Account and my account details, as required under Inter Governmental Agreement (IGA) signed by Indian Government, would be reported by I-Sec to the relevant tax authority identified in IGA. 2 1 1 2 9
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Nomination required : Yes No I have been explained about the benefits of the nomination facility. However, I would like to inform you that I do not wish to provide nomination for account. Nomination under section 45Z A of the Banking Regulation Act, 1949, and rule 2 (1) of the Banking Companies (Nomination) Rules, 1985, in respect bank deposits. I/We (name(s) & address(es) of the depositor(s) nominate the following person (details provided hereunder) to whom in the event of death the amount of deposit in the account. particulars where of are given below, may be returned by ICICI bank Limited. Branch (name and address of branch in which deposit is held). (NSDL circular number NSDL/POLICY/2009/004 dated January 9, 2009 1. As per NSDL guidelines, I confirm that I have been explained about the benefits of nomination facility to my /our demat account by the official. 2. I also understand that in the event of My demise, the process of Transmission will have to be followed by the legal heir as per the guidelines of NSDL by visiting the nearest branch offering Demat Services. 3. I/We the under signed do not wide to make a nomination in respect of my/our demat accounts. 4. Request you to kindly process my account opening form without the nomination facility. 3 12 3
First Year AMC Rs. 600 (Rs. 500 for customers receiving email statements) As per respective State Act Nil for e-instructions Nil for e-instructions A fee of Rs.25/- for every hundred securities or part thereof subject to maximum fee of Rs. 3,00,000; or a flat fee of Rs.25/- per certificate, whichever is higher. Reconversion of MF units Rs. 25/- per Instruction Annual Maintenance Fee for Corporate Accouts 500/- p.a. (w.e.f. 01 Oct. 2013) Rs. 500/- p.a. (w.e.f. 01 Oct. 2013) Sell - Market and Off-Market Reconversion of MF units into SoA Redemption of MF units through Participants Remat Pledge Creation 4.50/- per debit instruction (nil for commercial paper and short-term debt instruments) 10.00 per instruction 4.50 per instruction A fee of 10/- for every hundred securities or part thereof subject to maximum fee of 5,00,000; or a flat fee of 10/- per certificate, whichever is higher. 25 per instruction 4.50/- per debit instruction (nil for commercial paper and short-term debt instruments) 10.00 per instruction 4.50 per instruction A fee of 10/- for every hundred securities or part thereof subject to maximum fee of 5,00,000; or a flat fee of 10/- per certificate, whichever is higher. 25 per instruction 13
CONDITIONS 1. The value of shares and charges is calculated as per NSDL formula and rates. 2. There will be a charge of ` 100 for dishonour of any cheque or unsuccessful attempt to recover payment through direct debit or ECS. The depository services are liable to discontinuation if ICICI Bank is unable to recover charges from the customer for any reason whatsoever. In such cases there will be a charge of 250/- for resumption of services and the services will be resumed after a minimum of three working days from the date of receipt of request at Central Processing Office, Mumbai. 3. Any service that is not indicated above will be charged separately as per the rates applicable from time to time. 4. Service Tax and other Government taxes, levies, etc. applicable as per the prevailing rates will be charged in addition to these charges. 5. As per regulatory guidelines, if you close/shift your demat account, the portion of the advance Annual Service Charge applicable to the balance quarter(s) will be refunded. This is with effect from July 1, 2010. 6. ICICI Bank reserves the right to revise the tariff structure from time to time, & the same will be communicated to the customers with a notice of 30 days. 7. No charges are payable for opening of Demat accounts. or 25,000/- at customer id level. 750/- Debit Card Annual Charges 199/- + Service Tax for NRI Silver Debit Card 4 4 14
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This document is voluntary. Voluntary means that the document is not prescribed by Regulators, however the same is required by ICICI Securities Limited for offering the 3 in 1 account i.e. seamless trading platform with integrated bank account, demat account and broking account. If you do not wish to avail the services of ICICI Bank Limited and ICICI Securities Limited, you need not execute such documents. undertaken in compliance with Section 232 of The Companies Act, 2013 5 5 17
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Account Opening Form (For Individuals Only) Know Your Client (KYC) 21 Ver.26
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First Account holder Second Account holder Third Account holder 23
ICICI Bank Demat Services 24
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Veekay Printers / NRI Account Opening form Part A Ver.26 / 05.01.2015