REQUEST LETTER

Date Name Address :---------------------------------------------------------------------------------------------------------------------------:---------------------------------------------------------------------------------------------------------------------------:------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Telephone No. Email Address Passport No. Customer Identification No.
(for existing customers of ICICI Bank)

:---------------------------------------------------------------------------------------------------------------------------:---------------------------------------------------------------------------------------------------------------------------:---------------------------------------------------------------------------------------------------------------------------:----------------------------------------------------------------------------------------------------------------------------

M/s ICICI Bank Ltd, Mumbai.

Please find enclosed the following documents that I am sending through the PO BOX Service offered by ICICI Bank India.

Type of Document
Registration Form (Please do not attach any Cheque/ Demand Draft) Opening of an Additional Fixed Deposit/Savings Account Mandate Letter Nomination Form Request for Address Change Request a New Cheque Book Request for a Demand Draft Renewal of Term Deposit Home Loans - Application Form Home Loans - Power of Attorney Home Loans - Power of Attorney Check List Home Loans - Buyer Registration Form Home Loans - Seller Registration Form Other documents (please specify)

(Please tick)

Terms & Conditions
1. These terms and conditions are in addition to the terms and conditions provided on the website www.icicibank.com/nri 2. The users of the Post Box (PB) facility are availing the service at their own risk. 3. Neither ICICI Bank Ltd. (ICICI Bank) nor G3 Worldwide will be responsible or liable to the user or any third party for the “Envelopes/Consignments or its Contents” (collectively referred as “Consignments”) during the transit from the user to the PB. 4. On receipt of the Consignments in the PB, G3 worldwide shall be responsible for the Consignment to the user till it is transhipped and delivered to ICICI Bank - CPC NRI Cell, Mumbai. By availing the service of PB the user shall be deemed to have agreed to entrust the transhipment to India in his sole risk and discretion to G3 Worldwide and ICICI Bank is not liable or responsible for any loss or destruction of the Consignments in the hands of G3 Worldwide. 5. User is aware that ICICI Bank will not process the documents without furnishing this letter duly filled with and in the event no letter or incomplete information are furnished ICICI Bank is neither responsible to return the documents to the user or to keep it in safe custody.

6. In the event the users instruction/s cannot be carried out owing to any discrepancy or otherwise ICICI Bank may inform the user by email to the email ID furnished by the user. ICICI Bank is not responsible for non receipt of such email on account of any incorrect email ID or systemic error or non acceptance by the computer system of the user. 7. ICICI Bank shall in its sole discretion destroy the documents referred in Clause 5 and 6 above after six months of receipt without any further reference to the user and the user agrees that ICICI Bank is not liable or responsible to either user or any other person for such destruction. 8. User agrees that he shall be solely responsible for the contents of the Consignment and shall indemnify ICICI Bank for any loss or damage suffered to it on account of handling the contents or merely the letter being addressed to it in view of legal, regulatory or contractual requirements of the user.

I have read the terms and conditions on the website (www.icicibank.com/nri) and I confirm that I am not sending any kind of Monetary Instrument through this service. I understand that ICICI Bank has a right to reject any document that is not mentioned on the website (www.icicibank.com/nri). Yours Truly,

------------------------(Your Signature)