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MHW1/181D/1-1/WBF-M/03-12

MR.SAJJAN KUMAR . Your Base Branch: SCO 137, MAIN MARKET

SECTOR-13, KARNAL-132001,HARYANA INDIA
H NO. 256, VPO UPLANA, KARNAL
HARYANA - INDIA - 132039
Visit www.icicibank.com
Dial your Bank 9017667777

Did you know? It's mandatory to be KYC compliant as per RBI guidelines. If you have not submitted your KYC documents, please visit the nearest
branch or contact your Relationship Manager to complete KYC details for your Account.

Summary of Accounts held under Cust ID: 592337963 as on January 20, 2024
ACCOUNT DETAILS - INR
ACCOUNT TYPE A/c BALANCE(I) FIXED DEPOSITS (LINKED) BAL.(II) TOTAL BALANCE(I+II) NOMINATION
Savings A/c 204801839729 3,610,870.00 0.00 3,610,870.00 Registered
TOTAL 3,610,870.00 0.00 3,610,870.00

Statement of Transactions in Savings Account Number: 204801839729 in INR for the period July 20, 2023 - January 20, 2024
DATE MODE** PARTICULARS DEPOSITS WITHDRAWALS BALANCE
27-07-2023 B/F 3,600,734.00
UPI/334157497980/Oid202312071125/add-
01-08-2023 money@paytm/Paytm Payments 65.00 3,600,669.00
/PTM82e7ae392eb1486db2c2c2d395cfe7ad
UPI/334216620626/NA/Q380709098@ybl/Yes Bank
04-08-2023 Ltd/PTMab685bc8429a425cbba64b264a67da4b/ 200.00 3,600,469.00
UPI/370811598872/NA/8307995388@payt/Paytm
12-08-2023 Payments 200.00 3,600,269.00
/PTMd9a0fa6036d647a1904423d23c644cbe/
UPI/334228290225/Oid202312081439/paytm-
28-08-2023 63332333@/Paytm Payments 100.00 3,600,169.00
/PTM7631de863a8b4c10b11ec517ba6abe35
UPI/334220113129/Oid202312081511/paytm-
28-08-2023 31803969@/Paytm Payments 30.00 3,600,139.00
/PTMf45d4cc789ed4a8fa03a3a543c1ce1cb
UPI/370892236855/Oid202312081713/paytm-
05-09-2023 64584556@/Paytm Payments 10.00 3,600,129.00
/PTM9a12c35219854d61b2edead8df0a2665
UPI/334301438183/Oid202312091108/paytm-
19-09-2023 71062517@/Paytm Payments 20.00 3,600,109.00
/PTMcc84a12f501f46c995d071f3d71f8d18
UPI/334420638664/Oid202312101456/paytm-
02-10-2023 31803969@/Paytm Payments 30.00 3,600,079.00
/PTMa3fbef5e666a456086d2a18cf5e38e97
UPI/334462974566/Oid22583797291@/add-
11-10-2023 money@paytm/Paytm Payments 29.00 3,600,050.00
/PTM187a2444f31e4fda8eacde96940bc2fa
UPI/371083652316/UPI/hunnny.singh6@o/Paytm
11-10-2023 Payments /ICI1173475615374fa7b284ade3af8d11a6 10,000.00 3,610,050.00
UPI/334440351069/NA/8307995388@payt/Paytm
16-10-2023 Payments 5,000.00 3,605,050.00
/PTM093d3ac0f0a34a9e859260e60892cc0e/
UPI/371101302759/NA/Gopal Enterpris/Yes Bank
01-11-2023 Ltd/PTMd898de3dfc9349eeb865f9d38372ba54/ 1,000.00 3,604,050.00
UPI/371101373889/NA/Gopal Enterpris/Yes Bank
02-11-2023 Ltd/PTMf9a92fd1658b401f8096b06c909a8c8d/ 2,000.00 3,602,050.00
UPI/371101550696/NA/SAJJAN KUMAR4828@payt/Kotak
11-11-2023 Mahindra 5,000.00 3,607,050.00
/PTM3fed069a517a42abb39c336277f1950a
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MR.SAJJAN KUMAR .

DATE MODE** PARTICULARS DEPOSITS WITHDRAWALS BALANCE

UPI/437133504916/UPI/CHETAN FABRIC T/Kotak
25-11-2023 Mahindra 5,000.00 3,602,050.00
/ICI95ee910818bc42b0b024aa8ae65a0b27/
UPI/400546766425/NA/SAJJAN
KUMAR.57@paytm/Kotak
26-11-2023 Mahindra 11,200.00 3,613,250.00
/PTM5d9cf5f6693b4130b2bbb5af22ef4159
UPI/437162653732/Oid202401052209/add-
05-12-2023 money@paytm/Paytm Payments 190.00 3,613,060.00
/PTM0fb45b472f13490f8cdedc17c9855cc9
UPI/437200199904/NA/Chetan Fabric T/Kotak
12-12-2023 Mahindra 200.00 3,612,860.00
/PTM7a806c661fe54d1094d5d2558aaebb64/
UPI/400662823178/UPI/paytmqr28100505/Paytm
02-01-2024 Payments 10.00 3,612,850.00
/ICIe5e7c5b37e56437384c7a29d556d25f3/
UPI/437215107657/NA/999660010796@pa/Kotak
06-01-2024 Mahindra 200.00 3,612,650.00
/PTMe0dc3842f6024ed89b1c1532887febe9/
UPI/437206519886/UPI/paytmqro248c9pz/Paytm
06-01-2024 Payments 100.00 3,612,550.00
/ICI8e12e552732445c7b69e8bdcd737e9b8/
UPI/400609824547/UPI/paytm-59956675@/Paytm
06-01-2024 Payments /ICI0862afb2084240d09f9a7c9ad6fe1488/ 1,300.00 3,611,250.00
UPI/400648421993/UPI/paytm-59956675@/Paytm
08-01-2024 Payments /ICI3ec1ff1067104fd9981f700693722de0/ 190.00 3,611,060.00
UPI/437265233646/UPI/paytmqr1xqybyiy/Paytm
13-01-2024 Payments 10.00 3,611,050.00
/ICI8b187ebcdb5a473b9dbafb543afc2e58/
UPI/437267536391/UPI/sharmacommunica/HDFC
16-01-2024 BANK LTD/ICI3fead7b1ba614fa78c9795d4c4a29ef2/ 80.00 3,610,970.00
UPI/400618538904/na/bharatpe.900683/Federal
16-01-2024 Bank/ICIWC83FE186169802CF664E671ACDEC093/ 100.00 3,610,870.00
TOTAL 26,200.00 16,064.00 3,610,870.00

Account Related Other Information

ACCOUNT TYPE ACCOUNT NUMBER MICR CODE IFSC CODE NAME OF NOMINEE
Savings 204801839729 110485095 ICIC0006617 -

Nominee name is displayed only on specific consent of customer.

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MR.SAJJAN KUMAR .

Sincerely,

Team ICICI Bank.

This is a system-generated statement. Hence, it does not require any signature.

Legends for transactions in your account statement

VAT/MAT/NFS - Cash Withdrawal at other bank's ATM INF - Internet funds transfer in Linked accounts
EBA - Transaction at ICICIDirect BIL - Internet bill payment or Funds transfer to third party
VPS/IPS - Debit card transaction TOP - Mobile Recharge
RTGS - Real Time Gross Settlement (Instant Transfer of Rs 2 Lakh and up to Rs 10 Lakh) NEFT - National Electronic Fund Transfer (Up to Rs 10 Lakh)
• **Mode is available only for transaction done after August 6, 2013.

• As per prevailing guidelines of the Income tax Act, 1961 if a valid PAN is not provided by the • In absence of valid PAN, Form 15G / 15H shall not be treated as valid and tax will be deducted.
Customer then tax shall be deducted at the prevailing rate or 20%, whichever is higher. • In case your PAN is not updated in our record, please visit the nearest branch and provide a copy
• As per guidelines issued by CBDT on May 13, 2011, Form 16A (TDS Certificates) will be of the PAN card along with the original PAN card for verification.
generated
through the Income tax website for which the PAN of the customer needs to be necessarily updated •The address of the customer in Form 16A will be the last updated address in the data base of the
in Bank's record. Income tax department.

REGD ADDRESS: “LANDMARK”, RACE COURSE CIRCLE, VADODARA - 390 007, INDIA www.icicibank.com
This is an authenticated intimation/statement. Category of service: Banking & Financial Services.
Customers are requested to immediately notify the Bank of any discrepancy in the statement Registration No. MIV/ST/Bank & Finc/4.
MHW1-WBG-M-05-Mar-12/148405000053 - 525322040/207/207 - Utility - 1 of 1 PAN Based STC No. AAACI1195HSST001.