Consent and Declaration Form for Aadhaar Based Authentication/Verification

APPLICATION NO:

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I/We have been provided various options by IBank for establishing my/our identity/address
proof for opening the bank / home loan account and have voluntarily submitted my Aadhaar
to ICICI Bank (“Bank”) and hereby give my/ our consent to the Bank:- (i) to establish my/our
identity / address proof by Aadhaar based authentication system or verify the genuineness
of the Aadhaar through Quick Response (QR) code or through such other manner as set out
by UIDAI or any other law from time to time; (ii) share my/our Aadhaar detail with UIDAI,
NPCI, National Housing Board (NHB), concerned regulatory or statutory authorities as any
be required under applicable laws.

I/We hereby agree with the below terms pertaining to Aadhaar

based authentication/verification:

1. I/We have been informed that: (a) upon authentication, UIDAI may share with ICICI
Bank information in nature of my /our demographic information including photograph
which ICICI Bank may use as an identity/address proof for the purpose of account
opening; (b) my/our Aadhaar details (including my demographic information) shared
by UIDAI will not be used for any purpose other than the purpose mentioned above
or as per requirements of law; (c) my/our biometric information will not be stored by
the Bank.
2. I/We agree that the consent and purpose of collecting Aadhaar has been explained to
me/us in local language.

Applicable only for PMAY cases or subsidy related wherein Aadhaar number is captured for
eKYC:
Please tick the below declaration if you want to link your loan account through Aadhaar seeding to
receive Direct Benefit Transfer (“DBT”) benefits/subsidies into the account (NPCI MAPPING) 1:

I hereby declare that I do not have any loan account linked with National Payment
Corporation of India (NPCI) / National Housing Bank (NHB) for receiving Direct Benefit
Transfer and
I wish to link this loan account to directly receive the entitled benefits or subsidies.

Signature/Thumb Impression of Individual/ Proprietor / Partner / Authorised Signatory /

Beneficial Owner)

Name of home loan account holder: Date:

1 NPCI Mapping: Mapping is a process of associating a Bank with Aadhaar number which is facilitated by NPCI for Direct Benefit Transfer to the
respective bank who have linked the Aadhaar Number to a specific Bank account for receiving Direct benefits to which customer has given the consent