Tax Invoice

Branch Address Customer Details

Name: ICICI Bank Limited Customer Name: PREETHAM K

Address: ICICI Bank Towers, Bandra-Kurla Address:

Flat no, 1104, Cubatic
Complex, Mumbai, India Aloha apartment,

GSTIN of ICICI Bank: 27AAACI1195H3ZK GSTIN of Customer:

HSN Code: 9971 Date: 15/06/2022

Description of Service: ICICI Bank Travel Card Invoice No.: 220615064744

Place of Supply: Mumbai Travel Card No.:

Passport No.: R3968302 Travel Purpose:

Details of Travel Card:

Particulars Amount in Rs.

Travel Card Joining Fee

ICICI BANK Sapphiro Travel Card

2999.0

Total 2999.0
CGST @ CGST 0.0
SGST @ SGST 0.0
IGST @ 18 539.8199999999999
Total Amount 3538.82
Total Amount (in words): Rupees Three Thousand Five Hundred Thirty Eight And Eighty One Paisa Only
Whether tax payable under reverse charge: No
Declaration by Cardholder:
I hereby apply for the issuance of ICICI Bank Travel Card to me and declare that the information included in the application form is true and correct and that I am a resident Indian and that I am
eligible to apply for an internationally valid card. I accept that ICICI Bank is entitled in its absolute discretion to accept or reject this application without assigning reasons whatever. It is my
responsibility to obtain the terms and conditions applying to the ICICI Bank Travel Card separately and read the same. If this application is accepted, I will be bound by the terms and conditions
governing the ICICI Bank Travel Card, as may be in force from time to time and use of this card shall be deemed to be acceptance of these terms and conditions. I authorise ICICI Bank and/or its
associates to verify any information or otherwise at my office/residence or to contact me, my Employer/Banker/Credit Bureau/RBI or any other source to obtain or provide any information that
may be required for confirming membership requirements or maintaining my account in good standing. I agree to an ongoing confirmation for use of my name/address, email/mobile number for
marketing/merchandising offers between ICICI Bank and other companies. I understand and acknowledge that the local laws and RBI rules and regulations lay down norms and limits for purchase
and use of foreign exchange. I undertake that the usage of ICICI Bank Travel Card by me will be in accordance with the exchange control regulations of RBI and applicable laws in force from time
to time. In particular, and without limitation, the FEMA Act 1999, in event of failure on my part to do so or in the event of any information provided by me being incorrect and inaccurate. I agree
that I will be solely liable for any penalties and/or action under the local laws and/or regulations as may be in force, governing the purchase and use of this ICICI Bank Travel Card.

Niraj Tralshawala
Head - Payment Solutions & Consumer Finance.