Electronic Fund Transfer

I/We hereby declare that the particulars given below are correct and complete. If
any transaction is delayed or not effected at all for reason of incomplete or
incorrect information, I/We shall not hold ICICI Prudential Assets Management
Company Limited responsible.

I/We also undertake to advise any change in the particulars of my account to

facilitate updating of records for purpose of crediting account against monthly bill
raised through NEFT.

Date from which the mandate should be effective :

____________________________

Bank Name :
______________________________________________________________

Bank Branch Name & Address :

_____________________________________________

_______________________________________________________________________
____

_______________________________________________________________________
____

Branch code :
_____________________________________________________________

(9 digits code number appearing on the MICR band of the cheque supplied by Bank,
Please attach a Xerox copy of a cheque or a blank cheque of your bank duly
cancelled for ensuring accuracy of the bank name, branch name and code number)

Account Type : Saving _______________________ Current

______________________

Account no. (as appearing in the cheque book) _______________________________

_______________________________

(Signature of Authorised Signatory)

Place :
Date :