Customer Name Card Account No

MR GONAPA SREENADH 4035 XXXX XXXX 8008

C-82/2 GONAPA STREET,KANCHILI,MANDALAM,
CHINNAKHOJJIRIA,.
..
NEAR HANUMAN STATUE
SRIKAKULAM 532290

Statement Period

01/04/2022 TO 31/03/2023

TRANSACTION DETAILS
Card Number : 0000 XXXX XXXX 2538
International
Date Ref. Number Transaction Details Currency
amount
Amount(in `)
28-MAR-23 IGST-CI@18% 0.00 18.34

28-MAR-23 IGST-CI@18% 0.00 18.34

28-MAR-23 SR891597946/2733 Conv. Fee 1% on Rent Pay Trnx. Posted dt. 0.00 101.90
041222

28-MAR-23 SR891597946/2734 Conv. Fee 1% on Rent Pay Trnx. Posted dt. 0.00 101.90
071222

TRANSACTION DETAILS
Card Number : 4035 XXXX XXXX 8008
International
Date Ref. Number Transaction Details Currency
amount
Amount(in `)
06-APR-22 74766282097038736594265 PAY*MNR FURNITURE CENTE 0.00 29,500.00
SRIKAKULAM IN

30-APR-22 CLICK TO PAY PAYMENT RECEIVED 0.00 -29,500.00

14-AUG-22 74938262227000000271465 MADHAV FASHION HUBLI IN 0.00 756.00

14-AUG-22 74332742227222683751976 FLIPKART PAYMENTS GURGAON IN 0.00 1,044.00

16-AUG-22 74119662228228152847938 RAZ*Zomato Online Order Gurgaon IN 0.00 20.00

16-AUG-22 74119662228228152793215 RAZ*Zomato Online Order Gurgaon IN 0.00 759.45

17-AUG-22 74585192230041093829348 Reliance Retail Ltd DHARWAD IN 0.00 54.15

20-AUG-22 74056632233012283248195 HEALTHSECURE HOSPITAL CAR HUBLI IN 0.00 410.00

20-AUG-22 74332742233223294145618 APOLLO PHARMACY HUBLI IN 0.00 598.00

20-AUG-22 74056632233012283261958 HEALTHSECURE HOSPITAL CAR HUBLI IN 0.00 2,090.00

The category of service:Credit & Debit Card,Charge Card or Other payment Card service.
RegistrationNo.Mum/Div -III/ST/CDR/23. PAN based STC No:AAACI1195HST001.
REGISTERED OFFICE IS ICICI BANK LIMITED,"LANDMARK",RACE COURSE CIRCLE, VADODARA 390 007 , INDIA.
This is an authenticated intimation/statement.Customers are requested to immediately notify the Bank of any discrepancy in the statement
 TRANSACTION DETAILS
Card Number : 4035 XXXX XXXX 8008
International
Date Ref. Number Transaction Details Currency
amount
Amount(in `)
21-AUG-22 74332742234223325190061 WWW IRCTC CO IN GURGAON IN 0.00 1,077.97

21-AUG-22 74332742234223324731915 IRCTC BANGALORE IN 0.00 1,006.33

21-AUG-22 74332742235223382173199 FLIPKART PAYMENTS GURGAON IN 0.00 -1,044.00

21-AUG-22 74332742234223346738971 ST126 P V OPTICALS HUBLI IN 0.00 6,413.00

21-AUG-22 74056632234012291237858 INNOVITI POS HYDERABAD IN 0.00 1,098.00

21-AUG-22 74332742234223324454831 IRCTC BANGALORE IN 0.00 1,088.03

21-AUG-22 74332742234223323587003 IRCTC BANGALORE IN 0.00 475.29

21-AUG-22 74332742234223322809366 IRCTC BANGALORE IN 0.00 587.62

28-AUG-22 74163262241001103228475 BHP*SREE HARI HARA FOO Visakhapatnam 0.00 180.00

IN

28-AUG-22 74766512240234187373509 AUTOPE WWW.AUTOPE.IN IN 0.00 424.22

28-AUG-22 74332742241224082800406 HOTSTAR MUMBAI IN 0.00 149.00

29-AUG-22 Principal Amount Amortization - 0.00 1,033.75

<1/6>ST126 P V OPTICALS

29-AUG-22 HEALTHSECURE HOSPITAL CAR HUBLI IN 0.00 -2,090.00

29-AUG-22 HEALTHSECURE HOSPITAL CAR HUBLI IN 0.00 41.80

29-AUG-22 Interest Amount Amortization - 0.00 27.87

<1/6>HEALTHSECURE HOSPITAL CA

29-AUG-22 IGST-CI@18% 0.00 5.02

29-AUG-22 Principal Amount Amortization - 0.00 336.90

<1/6>HEALTHSECURE HOSPITAL C

29-AUG-22 ST126 P V OPTICALS HUBLI IN 0.00 128.26

29-AUG-22 ST126 P V OPTICALS HUBLI IN 0.00 -6,413.00

29-AUG-22 IGST-CI@18% 0.00 15.39

29-AUG-22 Interest Amount Amortization - <1/6>ST126 0.00 85.51

P V OPTICALS

29-AUG-22 IGST-CI@18% 0.00 23.09

29-AUG-22 IGST-CI@18% 0.00 7.52

30-AUG-22 74332742243224285647057 IRCTC BANGALORE IN 0.00 -210.00

30-AUG-22 220477835408 INFINITY PAYMENT RECEIVED, THANK YOU 0.00 -10,389.17

04-SEP-22 74332742248224773638837 SWIGGY MUMBAI IN 0.00 2,360.00

11-SEP-22 74056632255012407276422 HEALTHSECURE HOSPITAL CAR HUBLI IN 0.00 1,140.00

The category of service:Credit & Debit Card,Charge Card or Other payment Card service.
RegistrationNo.Mum/Div -III/ST/CDR/23. PAN based STC No:AAACI1195HST001.
REGISTERED OFFICE IS ICICI BANK LIMITED,"LANDMARK",RACE COURSE CIRCLE, VADODARA 390 007 , INDIA.
This is an authenticated intimation/statement.Customers are requested to immediately notify the Bank of any discrepancy in the statement
 TRANSACTION DETAILS
Card Number : 4035 XXXX XXXX 8008
International
Date Ref. Number Transaction Details Currency
amount
Amount(in `)
11-SEP-22 74056632255012407255152 HEALTHSECURE HOSPITAL CAR HUBLI IN 0.00 10,000.00

11-SEP-22 74056632255012405250262 HEALTHSECURE HOSPITAL CAR HUBLI IN 0.00 157.00

11-SEP-22 74056632255012405237004 HEALTHSECURE HOSPITAL CAR HUBLI IN 0.00 773.00

11-SEP-22 74056632255012407269013 HEALTHSECURE HOSPITAL CAR HUBLI IN 0.00 350.00

11-SEP-22 74056632255012407269039 HEALTHSECURE HOSPITAL CAR HUBLI IN 0.00 10,000.00

11-SEP-22 74056632255012407253397 HEALTHSECURE HOSPITAL CAR HUBLI IN 0.00 1,884.00

12-SEP-22 74056632256012413558481 HEALTHSECURE HOSPITAL CAR HUBLI IN 0.00 481.00

12-SEP-22 74056632256012413559943 HEALTHSECURE HOSPITAL CAR HUBLI IN 0.00 3,175.00

17-SEP-22 74332742261226060518699 MUFTI ALTERNATIVE CLOT HUBLI IN 0.00 3,099.00

17-SEP-22 74056632261012441080428 INNOVITI POS HYDERABAD IN 0.00 1,298.00

17-SEP-22 74766512260237398056214 SUDABI BRANDS PVT LT BANGALORE IN 0.00 4,056.00

19-SEP-22 74056632263012452247310 HEALTHSECURE HOSPITAL CAR HUBLI IN 0.00 192.00

19-SEP-22 74056632263012453388956 INNOVITI POS COCHIN IN 0.00 338.00

19-SEP-22 74056632263012452262913 HEALTHSECURE HOSPITAL CAR HUBLI IN 0.00 300.00

21-SEP-22 74332742265226469209219 ZOMATO LIMITED BANGALORE IN 0.00 348.50

21-SEP-22 74332742265226467829489 ZOMATO LIMITED BANGALORE IN 0.00 50.00

28-SEP-22 74332742272227159581827 AVN SAIGAL ENTERPRISES HUBLI IN 0.00 805.00

28-SEP-22 74332742272227162055413 ZOMATO LIMITED BANGALORE IN 0.00 296.20

29-SEP-22 Principal Amount Amortization - 0.00 341.40

<2/6>HEALTHSECURE HOSPITAL C

29-SEP-22 IGST-CI@18% 0.00 4.21

29-SEP-22 IGST-CI@18% 0.00 12.91

29-SEP-22 Principal Amount Amortization - 0.00 1,047.54

<2/6>ST126 P V OPTICALS

29-SEP-22 Interest Amount Amortization - 0.00 23.37

<2/6>HEALTHSECURE HOSPITAL CA

29-SEP-22 Interest Amount Amortization - <2/6>ST126 0.00 71.72

P V OPTICALS

30-SEP-22 74332742274227338985947 Zomato Online Order BANGALORE IN 0.00 474.49

03-OCT-22 220505327931 INFINITY PAYMENT RECEIVED, THANK YOU 0.00 -39,393.00

08-OCT-22 74056632282012559320322 INNOVITI POS COCHIN IN 0.00 499.00

The category of service:Credit & Debit Card,Charge Card or Other payment Card service.
RegistrationNo.Mum/Div -III/ST/CDR/23. PAN based STC No:AAACI1195HST001.
REGISTERED OFFICE IS ICICI BANK LIMITED,"LANDMARK",RACE COURSE CIRCLE, VADODARA 390 007 , INDIA.
This is an authenticated intimation/statement.Customers are requested to immediately notify the Bank of any discrepancy in the statement
 TRANSACTION DETAILS
Card Number : 4035 XXXX XXXX 8008
International
Date Ref. Number Transaction Details Currency
amount
Amount(in `)
10-OCT-22 74332742284228318360661 Zomato Online Order BANGALORE IN 0.00 208.80

12-OCT-22 74056632286012582611248 INNOVITI POS HYDERABAD IN 0.00 1,113.00

12-OCT-22 24028022286000727902162 MSW*RAJENDRA STORES Dharwad IN 0.00 1,040.00

29-OCT-22 Interest Amount Amortization - 0.00 18.82

<3/6>HEALTHSECURE HOSPITAL CA

29-OCT-22 Principal Amount Amortization - 0.00 1,061.50

<3/6>ST126 P V OPTICALS

29-OCT-22 Principal Amount Amortization - 0.00 345.95

<3/6>HEALTHSECURE HOSPITAL C

29-OCT-22 Interest Amount Amortization - <3/6>ST126 0.00 57.76

P V OPTICALS

30-OCT-22 74332742304230348682268 APOLLO PHARMACY HUBLI IN 0.00 50.04

30-OCT-22 IGST-CI@18% 0.00 3.39

30-OCT-22 IGST-CI@18% 0.00 10.40

02-NOV-22 74332742307230608782292 INKA050 BANGALORE IN 0.00 14,167.00

05-NOV-22 74332742310230976509389 RISHTA APPARELS PRIVAT HUBLI IN 0.00 1,400.00

05-NOV-22 74332742310230981716227 AVN SAIGAL ENTERPRISES HUBLI IN 0.00 3,894.00

05-NOV-22 74332742310230973684110 ZUDIO A UNIT OF TRENT HUBLI IN 0.00 149.00

05-NOV-22 230963241640 UPI Payment Received 0.00 -6,336.14

05-NOV-22 800805112022S69928053 NEFT PAYMENT RECEIVED 0.00 -1.00

08-NOV-22 74332742313231218964330 PAYTM RENTAL NOIDA IN 0.00 10,175.00

10-NOV-22 74332742315231417137769 ZOMATO LIMITED BANGALORE IN 0.00 419.05

14-NOV-22 74056632319231857154863 Flipkart Internet Pvt BANGALORE IN 0.00 1,899.00

16-NOV-22 74332742321232023471214 PAYTM RENTAL NOIDA IN 0.00 3,052.50

18-NOV-22 74332742323232213298219 ZOMATO NEW DELHI IN 0.00 419.05

20-NOV-22 74056632325232431091250 Flipkart Internet Pvt Ltd BANGALORE IN 0.00 1,699.00

23-NOV-22 74332742328232785295184 ZOMATO NEW DELHI IN 0.00 373.50

24-NOV-22 74332742329232831919273 ZOMATO NEW DELHI IN 0.00 284.20

28-NOV-22 74332742333233240122552 ZOMATO NEW DELHI IN 0.00 369.70

29-NOV-22 Principal Amount Amortization - 0.00 350.56

<4/6>HEALTHSECURE HOSPITAL C

The category of service:Credit & Debit Card,Charge Card or Other payment Card service.
RegistrationNo.Mum/Div -III/ST/CDR/23. PAN based STC No:AAACI1195HST001.
REGISTERED OFFICE IS ICICI BANK LIMITED,"LANDMARK",RACE COURSE CIRCLE, VADODARA 390 007 , INDIA.
This is an authenticated intimation/statement.Customers are requested to immediately notify the Bank of any discrepancy in the statement
 TRANSACTION DETAILS
Card Number : 4035 XXXX XXXX 8008
International
Date Ref. Number Transaction Details Currency
amount
Amount(in `)
29-NOV-22 Principal Amount Amortization - 0.00 1,075.66
<4/6>ST126 P V OPTICALS

29-NOV-22 IGST-CI@18% 0.00 7.85

29-NOV-22 Interest Amount Amortization - <4/6>ST126 0.00 43.60

P V OPTICALS

29-NOV-22 Interest Amount Amortization - 0.00 14.21

<4/6>HEALTHSECURE HOSPITAL CA

29-NOV-22 IGST-CI@18% 0.00 2.56

01-DEC-22 233534949280 UPI Payment Received 0.00 -37,121.46

02-DEC-22 74332742337233616380483 PAYTM RENTAL NOIDA IN 0.00 10,190.00

03-DEC-22 74332742338233766430525 RELIANCE RETAIL LIMITE NOIDA IN 0.00 2,233.32

03-DEC-22 74332742338233780731924 ADITYA BIRLA FASHION A HUBLI IN 0.00 5,655.00

03-DEC-22 74332742338233790486907 RELIANCE RETAIL LIMITE NOIDA IN 0.00 -781.66

03-DEC-22 74056632338233781280357 Flipkart Internet Pvt Ltd BANGALORE IN 0.00 1,115.00

04-DEC-22 74332742339233853124592 ZOMATO NEW DELHI IN 0.00 601.50

04-DEC-22 74056632339233896190979 Flipkart Internet Pvt Ltd BANGALORE IN 0.00 183.00

04-DEC-22 74056632339233896318133 Flipkart Internet Pvt Ltd BANGALORE IN 0.00 -1,115.00

04-DEC-22 74056632339233896193999 Flipkart Internet Pvt Ltd BANGALORE IN 0.00 799.00

06-DEC-22 74332742341234018501688 PAYTM RENTAL NOIDA IN 0.00 10,190.00

07-DEC-22 74332742342234166012321 ZOMATO NEW DELHI IN 0.00 376.00

11-DEC-22 74056632346234573283302 Flipkart Internet Pvt Ltd BANGALORE IN 0.00 579.00

11-DEC-22 74056632346234573276645 Flipkart Internet Pvt Ltd BANGALORE IN 0.00 793.00

12-DEC-22 74332742347234604184273 ZOMATO NEW DELHI IN 0.00 467.35

15-DEC-22 74056632350234923171549 Flipkart Internet Pvt Ltd BANGALORE IN 0.00 1,110.00

17-DEC-22 74332742352235127236674 NETFLIX MUMBAI IN 0.00 199.00

27-DEC-22 74332742362236113254430 RELIANCE RETAIL LIMITE NOIDA IN 0.00 -747.66

27-DEC-22 74332742362236112678613 RELIANCE RETAIL LIMITE NOIDA IN 0.00 -704.00

29-DEC-22 IGST-CI@18% 0.00 5.27

29-DEC-22 IGST-CI@18% 0.00 1.72

29-DEC-22 Interest Amount Amortization - 0.00 9.54

<5/6>HEALTHSECURE HOSPITAL CA

The category of service:Credit & Debit Card,Charge Card or Other payment Card service.
RegistrationNo.Mum/Div -III/ST/CDR/23. PAN based STC No:AAACI1195HST001.
REGISTERED OFFICE IS ICICI BANK LIMITED,"LANDMARK",RACE COURSE CIRCLE, VADODARA 390 007 , INDIA.
This is an authenticated intimation/statement.Customers are requested to immediately notify the Bank of any discrepancy in the statement
 TRANSACTION DETAILS
Card Number : 4035 XXXX XXXX 8008
International
Date Ref. Number Transaction Details Currency
amount
Amount(in `)
29-DEC-22 Principal Amount Amortization - 0.00 1,090.00
<5/6>ST126 P V OPTICALS

29-DEC-22 Interest Amount Amortization - <5/6>ST126 0.00 29.26

P V OPTICALS

29-DEC-22 Principal Amount Amortization - 0.00 355.23

<5/6>HEALTHSECURE HOSPITAL C

04-JAN-23 74332743005300417372321 PAYTM RENTAL NOIDA IN 0.00 20,460.00

04-JAN-23 300440177150 UPI Payment Received 0.00 -36,815.35

05-JAN-23 Convenience Fee on RentPay 1% 0.00 204.60

05-JAN-23 IGST-CI@18% 0.00 36.83

09-JAN-23 74332743010300937923069 BARATAM BROTHERS SRIKAKULAM IN 0.00 10,716.00

14-JAN-23 74332743015301460854379 PAYTM RENTAL NOIDA IN 0.00 10,230.00

15-JAN-23 IGST-CI@18% 0.00 18.41

15-JAN-23 Convenience Fee on RentPay 1% 0.00 102.30

17-JAN-23 74332743019301733724157 NETFLIX NETFLIX IN 0.00 199.00

21-JAN-23 74056633022302145558102 FLIPKART BANGALORE IN 0.00 314.00

21-JAN-23 74056633022302145437422 FLIPKART BANGALORE IN 0.00 228.00

22-JAN-23 74056633023302255290222 FLIPKART BANGALORE IN 0.00 409.00

27-JAN-23 74056633028302709812923 Flipkart Internet Pvt Ltd BANGALORE IN 0.00 549.00

29-JAN-23 Principal Amount Amortization - 0.00 1,104.55

<6/6>ST126 P V OPTICALS

29-JAN-23 Interest Amount Amortization - 0.00 4.80

<6/6>HEALTHSECURE HOSPITAL CA

29-JAN-23 Principal Amount Amortization - 0.00 359.96

<6/6>HEALTHSECURE HOSPITAL C

29-JAN-23 IGST-CI@18% 0.00 2.65

29-JAN-23 IGST-CI@18% 0.00 0.86

29-JAN-23 Interest Amount Amortization - <6/6>ST126 0.00 14.73

P V OPTICALS

31-JAN-23 303110117442 UPI Payment Received 0.00 -44,995.00

07-MAR-23 74332743067306662638360 NETFLIX MUMBAI IN 0.00 199.00

11-MAR-23 74056633071307056930679 Paytm_FlipkartInternet BANGALORE IN 0.00 502.00

17-MAR-23 74056633077307627947552 Paytm_FlipkartInternet BANGALORE IN 0.00 -502.00

The category of service:Credit & Debit Card,Charge Card or Other payment Card service.
RegistrationNo.Mum/Div -III/ST/CDR/23. PAN based STC No:AAACI1195HST001.
REGISTERED OFFICE IS ICICI BANK LIMITED,"LANDMARK",RACE COURSE CIRCLE, VADODARA 390 007 , INDIA.
This is an authenticated intimation/statement.Customers are requested to immediately notify the Bank of any discrepancy in the statement
 TRANSACTION DETAILS
Card Number : 4035 XXXX XXXX 8008
International
Date Ref. Number Transaction Details Currency
amount
Amount(in `)
19-MAR-23 74056633079307846695857 Flipkart Payments BANGALORE IN 0.00 1,499.00

19-MAR-23 74332743079307801640685 PAYTM RENTAL NOIDA IN 0.00 5,110.00

20-MAR-23 Convenience Fee on RentPay 1% 0.00 51.10

20-MAR-23 IGST-CI@18% 0.00 9.20

31-MAR-23 74332743091309021413277 BHARAT PETROLEUM CORPO 0.00 433.43

BHUBANESHWAR IN

For ICICI Bank Limited.

Sudipta Roy
Head – Consumer Cards

Important Messages
Safe Banking Tips - Do not transact if you find any suspicious device attached to the ATM. Do not take help
from strangers at an ATM.

ICICI Bank Credit Cards Goods and Services Tax Identification Number (GSTIN) is 27AAACI1195H3ZK

HSN Code for service: 9971 - Financial and related services

Our registered office address : ICICI Bank Tower, Bandra Kurla Complex, MUMBAI, Mumbai Suburban,
Maharashtra - 400051

Making only minimum payment every month can lead to repayment stretching over years with consequent
interest payment on outstanding balance

Please pay your credit card outstanding before the payment due date to avoid penal fees and interest
charges.

For payments made through cheque, we request you to make the payment atleast 3 working days before the
due date incase of an ICICI Bank cheque and 5 working days before the due date for Non-ICICI Bank cheques.

For any clarification or more information, you may contact us through the 'Get in Touch' option at
www.icicibank.com

* Mark-up fee and corresponding GST levied is included in the transaction amount displayed

The category of service:Credit & Debit Card,Charge Card or Other payment Card service.
RegistrationNo.Mum/Div -III/ST/CDR/23. PAN based STC No:AAACI1195HST001.
REGISTERED OFFICE IS ICICI BANK LIMITED,"LANDMARK",RACE COURSE CIRCLE, VADODARA 390 007 , INDIA.
This is an authenticated intimation/statement.Customers are requested to immediately notify the Bank of any discrepancy in the statement