EP000166935

Sourcing Channel
Branches
PERSONAL LOAN DSA
APPLICATION FORM Alternate
.Please use CAPITAL LETTERS only. .Please Tick wherever Applicable. .All fields are mandatory.

FOR BANK USE ONLY

SOL ID RM NAME SHRAVANI B-423570 Employee No. 503234 Date

Channel Name DSA Executive Name PL DSA Executive Code PLDSA001

DSA Code FINFREE ENTERPRISES-PL

VSTS Code CRM ID/IKART ID

Application Type: New Update KYC Number 50004648916947 (Mandatory for KYC update request)

Account Type: Normal

PERSONAL DETAILS

Title Mr. Mrs. Miss Others_________ APPLICANT CO-APPLICANT

Name LEKKALA KONDA REDDY KONDA REDDY
Maiden Name
Father's Name SHANKAR REDDY
Mother's Name PARAVATHAMMA
Spouse Name SUSHAANI DOB
Date of birth 16-08-1988 Gender: Male Female Transgender | Religion: HINDU
Education Professional Diploma Holder Graduate Post Graduate Under Graduate/Matriculate
Customer Category General SC ST OBC Other __________| Marital Status: Married Single Others______
Residence Address L KONDA REDDY CCPL COLONYKALLUR WORKS CHINCHOLI TALUK

City/Town/Village HUBLI District BIDAR

Nearest Landmark .
State KARNATAKA PIN 585305 Tel( R ) -
Residence is Self Owned Rented Company provided Other ________________
Residence Type Bunglow(B) Row House(R) Flat(F) Other(O)________________
No.of years at above residence 4 Yrs 0 Months Tick,if Permanent Address is same as Residence Address
Permanent Address L KONDA REDDY CCPL COLONYKALLUR WORKS CHINCHOLI TALUK

City/Town/Village HUBLI District BIDAR

Landmark . State KARNATAKA PIN 585305
Tel( R ) - Location Category Rural Semi Urban Urban Metro
Additional Address

District
City/Town/Village State PIN
Nearest Landmark Tel( R ) -

Mobile No. 9449199049 Email ID KONDALEKKALA@GMAIL.COM

Gross Income 60000 (per annum) UID No XXXX-XXXX-0289
Citizenship IN-Indian Others (ISO 3166 Country Code) No. of Dependents
Residential Status Non-resident Individual Person of Indian Origin Foreign National Resident Individual

PREFERRED MAILING ADDRESS

Subscription for statement by Email/Mobile Alerts Residence (R) Office (O)

Name:LEKKALA KONDA REDDY KONDA REDDY
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DETAILS OF FACILITY REQUIRED*
Credit Facility Amount 1500000 Tenure 60 Months *Subject to Approval
Purpose of Facility Education Travel Occasion in Family Purchase of Household/ Electronic Goods
Home Renovation / Extension Others _________________
Utilisation District BIDAR Utilisation Taluka
Occupation OTHERS
Division OTHERS
Sub Division OTHERS
Activity OTHERS
OCCUPATIONAL DETAILS
Private Sector Public Sector Government Sector
Occupation Retired Housewife Salaried Others _________________

Pvt.Ltd. Partnership Proprietor Public Ltd. Ltd. Liability co.

Type of company Retailers PSU Govt MNC Others_______

If Salaried / Automobile Agriculture based Banking BPO Capital goods Telecom IT Retail
Constitution Occupation Real Estate Consumer Durables FMCG NBFC Marketing/Adv. Pharma Media Other_
Name Education Electricity,gas&water supply Health&Social Work Fishing Mining&Quarrying Transportation

Public Administrations / Defense Hospitality Trader / Distributor Comm. Agent Retailer

Employer Details Designation: Operator Total Exp injob: 12 Yrs 5 Months

Exp.in Currentjob: 4 Yrs 0 Months
Emp ID YW8
Company/Employer Name CHETTINAD CEMENT CORPORATION LIMITED
Company/Employer Address CHETTINAD CEMENT CORPORATE PVT LTDKALLUR WORKS BHAKTSAMPALLI
VILLAGECHINCHOLI TAKUL

Landmark .
City PIN Code 585305
State Country
Tel(0) - Mobile 9156484648
Office e-mail ID KONDALEKKALA@GMAIL.COM

BANK DETAILS (Primary Bank)

Name of Bank HDFC BANK LTD. Branch CHATSSALA

A/C. No. 50100197995323 UPI/VPA
Account Type Saving Current OC/CC if Overdraft,Limit: No.of years:
Existing relationship with ICICI: CC HH AL PL ENACH Registration Mode: Net Banking Debit Card

PROOF OF IDENTITY(POI) (Certified copy of any one of the following POI needs to be submitted)

A-Passport Number Expiry Date

B-Voter ID Card
C-National Population Register Letter
D - Driving License Expiry Date
E-UID( Aadhar) 0289 or VID No.
F-NREGA Job Card
Z-Other(any docment notified by government) Identification No.
S-Simplified Measures Account-Document Type Code Identification No.

PROOF OF ADDRESS(POA) Current/ Permanent/ Overseas Address Details (Certified copy of any one of the following POA needs to be submitted)

Address Type Residential Business Registered Office Unspecified

Proof of Address Passport Driving License UID(Aadhar) Voter ID card NREGA Job Card
National Population Register Letter Other Simplified Measures account- Document Type Code
Current address(correspondence/local address):State/ UT code: KARNATAKA ISO 3166 Country Code INDIA
Permanent Address: State/ UT code: KARNATAKA ISO 3166 Country code: INDIA
Overseas Address: ISO 3166 Country code

Name:LEKKALA KONDA REDDY KONDA REDDY

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 INSURANCE INTENT DECLARATION
I/We hereby declare that I/We would like to opt for insurance plan offered by insurance company in association with ICICI Bank.I/ We have
carefully read and understood the contents of brochure.
I/We have understood that the insurance premium shall be deducted from the loan amount sanctioned by ICICI Bank and I hereby authorize
ICICI Bank to deduct the insurance premium from sanctioned loan amount and disburse only the remaining loan amount.

I confirm that I am voluntarily participating in this programme and am aware that the loan is available without insurance as well

Signature of the Applicant

CONSENT FOR ICICI BANK(GDPR Declaration)

Yes for ICICI Group Companies Yes for partners of ICICI Bank Yes for both Not for both

Mode of marketing By E-Mail By Post By SMS/Text By Social Media By Telephone / Call

By Whatsapp No to marketing by all Yes to marketing by all

TICK YOUR CHOICE OF CARD* (Tick just one)

Product Net Monthly Joining Fee Annual Fee Minimum Spends Large Pricing
Income(*) (2nd year Onwards) for Annual fee reversal
ICICI Bank Sapphtro CreditCard 1,50,000 and above NIL 3500 5,00,000 412 TW

ICICI Bank Rubyx CreditCard 45,000 and above NIL 2500 3,00,000 435 TS

ICICI Bank Coral CreditCard 20,000 and above NIL 500 1,50,000 365 PW

ICICI Bank Maturity Trip Platinum Card 20,000 and above 500 NA NA 443 JF

ICICI Bank Manchester United Platinum Card 20,000 and above 499 NA 1,25,000 418 PF

FEES & CHARGES* Overdue Interest on extended credit Interest on cash advances
Monthly Annual Monthly Annual
ICICI Bank Card 3.40% 40.80% 3.40% 40.80%
Signature of the Applicant
Subscription for statement by Email Mobile Alerts *GST Charges are Applicable
Name to be printed on Credit Card*(Maximum 19 characters, including spaces)

REFERENCES (PREFERABLY FRIEND/COLLEAGUE)

1. Name KUMAR Relationship Friend

Address HYDRABAD
Pincode 500085 Tel/Mob No. 8500068661
Email ID

2. Name HEMANTH REDDY Relationship Friend

Address BANGALORE
Pincode 560067 Tel/Mob No. 9878898594
Email ID

Name:LEKKALA KONDA REDDY KONDA REDDY

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 DECLARATION
I/We have no objection to ICICI Bank Limited, its group companies, agents/representatives to provide me/us information on various products,
offers & services provided by ICICI Bank Limited/ its group companies through any mode (including without limitation through telephone calls/
SMSs/emails) and authorize ICICI Bank Limited, Its group companies, agents I representatives for the above purpose. Please tick Yes or No, as
acceptable#
COMMON DECLARATIONS
1. I/We declare that all the particulars and information and details
given/filled in this application form are true, correct,complete and up-
to-date in all respects and that I/We have notwithheld any
information whatsoever.
2. I hereby declare that the details furnished above are true and
correct to the best of my knowledge and belief and I undertake to
inform you of any changes therein, immediately. In case any of the
above information is found to be false or untrue or misleading or
misrepresenting. I am aware that I may be held liable for it.
3. I hereby consent to receiving information from Central KYC
Registry through SMS / Email on the above registered number/email
address.
4. I/ We confirm that no insolvency proceedings or suits for recovery
of outstanding dues or monies whatsoever and/ or any criminal
proceedings have been initiated and/or are pending against me/us
and that I / we have been never adjudicated insolvent by any court or
other authority.
5. No action nor other steps have been taken or legal proceedings
started by or against me/us in any court of law/ other authorities for
Winding up, dissolution, administration or reorganization or for the
appointment of a receiver, administrator, administrative receiver,
trustee or similar officer or for my/our assets.
6. I/We declare that I/we have not made any payment in cash, bearer
cheque or kind along with or in connection with this application to
the executive or kind along with or in connection with this
application to the executive such payment made by us to the
executive collecting this application.
7. l/We understand and confirm that the Application Form and all
other documents submitted by me/us to ICICI Bank shall not be
returned to me/us and ICICI Bank shall have the right to retain the
same.
8. I/ We authorize ICICI Bank Limited (ICICI Bank) and their
agents to exchange, share or part with all information and data
maintained with ICICI Bank relating to my/ our existing account
related information including existing or prior loans and repayment
history to other ICICI group companies, banks, financial
institutions, credit bureau, agencies, mobile network operators
directly or indirectly, statutory bodies and other service providers of
ICICI Bank as may be required and I/We shall not hold ICICI Bank
(or any of its group companies) liable for sharing such information.
9. I/We understand and acknowledge that ICICI Bank shall have the
absolute discretion, without assigning any reasons (unless required
by applicable law), to reject our application and that ICICI Bank
shall not be responsible/liable in any manner whatsoever to me/us for
such rejection or any delay in notifying me/us of such rejection and
any costs, losses, damages or expenses, or other consequences, caused
by reason of such rejection, or any delay in notifying me/us of such
rejection,of our application.
10. Except to the extent disclosed to ICICI Bank, no director or a
relative/near relation (as specified by RBI) of a director of a banking
company (including ICICI Bank) or a relative/near relation (as
specified by RBI) of a senior officer of ICICI Bank (as specified by
RBI) is the Applicant(s),or a partner of concern, or of our
subsidiary, or our holding company, or a guarantor on my/our
behalf, or holds substantial interest in our concern or my/our
subsidiary or holding company.
Yes No
13. II/We declare and undertake that the Credit Cards issued to me
/us,if used overseas, shall be utilised strictly in accordance with the
relevant exchange control regulations issued & as amended by the
Reserve Bank of India(RBI) from time to time. In the event I/we
exceed my/our entitlements as per the exchange control guide-lines
of RBI, I/we undertake to bring the same immediately to the notice
of ICICI Bank Limited in writing. Further, I/we also agree and
understand that if I/we am/are required to get my/our passport
endorsed for any charges incurred by me/us as stipulated by RBI,
the onus of getting my/our passport endorsed shall lie entirely on me
/us. In the event of any failure to comply with the prevailing
exchange control guidelines issued by RBI to me/us, I/we shall be
liable for any action under the Foreign Exchange Management Act,
1999, as amended and be debarred from the Credit Card facility
either at ICICI Bank Limited instance or by RBI.
14. In the event of a Credit Card programme closure or at the time
of renewal of Credit Card, ICICI Bank Limited at its sole discretion
reserves the right to provide a card type that is different from the
existing card type held by the Cardholder. The credit limits and cash
limits on any Credit Card at any point in time are as per sole
discretion of ICICI Bank Limited. The card application shall
continue to be valid for any replacement card provided at the time of
closure/renewal. Internationally valid Card and all other Cards
cannot be used on Internet or otherwise for purchase of prohibited
items like lottery tickets, banned or proscribed magazines,
participation in sweepstakes, payment for callback services,
remittance in any form towards overseas forex trading, margin calls
to overseas exchanges/overseas counter party, trading in foreign
exchange in domestic/overseas markets etc.
15.I/We have read the application form and brochures and am/are
aware of all the terms / conditions of availing finance from ICICI
Bank Limited. I/We authorise ICICI Bank Limited to make
references and enquiries related to information in this application
which, ICICI Bank Limited consider necessary. I/We undertake to
inform ICICI Bank Limited regarding change in my/our residence
/employment and to provide any further information that ICICI
Bank Limited may require. I confirm that I have gone through all
the Terms& Conditions, Most Important Terms & Conditions and
Important Credit Card Declaration and hereby agree to abide by the
same.
16.For cash withdrawals, interests will be charged from the day of
transaction and no free credit period will be provided.
17.I hereby give consent to ICICI Bank for linking my ICICI Bank
credit card with my existing ICICI Bank savings/current account, if
any. I understand that this would enable me to access my ICICI
Bank credit card account using the existing user ID provided to me
under my ICICI Bank savings/current account, if any, through
internet banking and iMobile facility. I further understand that I
may delink my ICICI Bank savings/current account from my ICICI
credit card by calling ICICI Customer Care number available at
www.icicibank.com
18.I understand that under the alert facility,ICICI Bank will enable
me to receive customer message alerts with respect to events/
transactions relating to my Credit Card or informational/
promotional mail that will be useful to me over my mobile phone or
through e-mail. I agree to receive communication on my alternate e-
mail ID in case the alert messages with respect to any event /
transaction are not delivered to my preferred e-mail ID.(subject to
information provided in the Application Form). I agree to abide by
the Terms & Conditions of ICICI Bank in this regard.
For Credit Card
11.Issuance of the said Credit Card is at the sole discretion of ICICI
Bank Ltd. The credit limits on the Credit Card account will be fixed
by the bank based on my income documents.
12.The Cardholder shall be entitled to apply for a review
/enhancement/reduction of the credit Limit and/or Cash Limit (if
provided by ICICI Bank), upon completion of 12 months of his/her
membership. Alterations upon such review, if any, of the Credit
Limit and/or Cash Limit will be at the sole discretion of ICICI Bank
ICICI Bank shall at its sole discretion be. entitled to review
(including enhancement or reduction) of the Credit Limit and/or
Cash Limit assigned on the Card at any time & only enhancements,
if any, to the Credit Limit &/or the Cash Limit, shall be effected by
ICICI Bank with the consent of the Cardholder.
19.I hereby authorise ICICI Bank Ltd (“ICICI Bank”) to share my
data or information associated with my MakeMyTrip ICICI Bank
Credit Card ("Card application”) (i) E-mail ID; (ii) Mobile number;
(iii) Card variant availed of (Platinum); (iv) Credit Card account
number with MakeMyTrip (India) Private Limited and its affiliates
(“MMT”) to update its records and provide me services, rewards &
benefits with respect to the Card. E-mail ID provided by me in the
Card application does not have a corresponding MMT account,
MMT shall provide me with services, rewards & benefits associated
with the Card on my MMT account linked to my mobile number. In
case my e-mail ID or mobile number are not present in any MMT
account, MMT shall create a new MMT account on my behalf with
my e-mail ID and/or mobile number, provided under the Card
application. MMT shall update me with details of the new MMT
account and steps to access the new MMT account by way of an SMS
and/or e-mail.

END USE DECLARATION

I hereby represent, warrant and confirm that the loan has been taken for a valid purpose and is not speculative or illegal in any manner. I also
declare that funds under the facility will not be used towards purchase of gold in any form, including primary gold, gold bullion, gold jewellery,
gold coins, units of gold exchange traded funds(ETF) and units of gold, mutual funds etc. The facility either in part or full will not be used for
investment in capital market, land acquisition, promoters contribution in the project or any other purpose, which is prohibited or any illegal
activity. I further agree, confirm and undertake that the purpose of use of funds under the loan shall not be changed in any manner during the
tenor of loan, or that such change in purpose shall take place only with the prior written permission of ICICI Bank. I agree that any breach or
default in complying with all or any of the aforesaid undertaking(s) will constitute an event of default under the facility documents.
“Disclaimer: Point 11 to19 are for Credit Card application only”

DETAILS OF CHARGES

Interest Rate* % per annum

Processing Fee(Non refundable)* up to 2.25% of loan amount plus GST if others please specify

Prepayment Charges* 5% of principal outstanding plus GST if others please specify

*(Subject to change as per bank's discretion from time to time)

Note: Please visit http://www.icicibank.comfor detailed charges & fees under the respective loan product. Changes
in charges from time to time are updated on bank’s website.

Name:LEKKALA KONDA REDDY KONDA REDDY

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