PRELIMINARY CREDIT FACILITY APPLICATION FORM

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PRELIMINARY CREDIT FACILITY APPLICATION FORM

2 iSMART Domestic Educational Loans

iSMART International Educational Loans Education Loans (Excluding iSMART Institutes) PO Program Education Loans

Date :

Loan Amount Required :

Please Affix Recent Passport size Photograph (Self attested) Please Affix Recent Passport size Photograph (Self attested)

Existing Relationships with ICICI Group

(Mandatory for KYC update required)

(Mention Credit Card / Bank A/c / Loan A/c No. above)

Application Type* New Update Loans Credit Card Bank Account KYC Number

Account Type* Normal Simplified(for low risk customers) Small

SOL ID RM Name Employee No. Ref. by .

For Bank Use Only

DSA name_______________________________________________ DSE name____________________________________________________ DSA Code CRM ID

Channel Name ________________________________________________________________________________________________________ Promo Code

Ref by PB/ VB/ SALARY/ WEALTH/ BLG/ BRANCH/ FOREX________________________________________________________________________

Institution/ University(N) Name of the Course

Duration of Course Country:

Date of commencement of course Level of Course: Graduate Post Graduate Professional Diploma

Yrs Mths

Course Details

Personal Details of the Applicant (for students)

D D M M Y Y Y Y

Prefix First Name Middle Name Surname

Name

Father’s / Spouse Name Mother’s Name

Applicant’s Maiden Name

Date of Birth Gender: Male Female Transgender Marital status: Married Single Others Education: Post Graduate Professional Diploma Holder Graduate Under Graduate/ Matriculate

Customer Category: General SC ST OBC MBC Others

Religion: Hindu Muslim Sikh Zoroastrian Christianity Buddhist Others Current Address

City/ Town/ Village District State Code Pin

Nearest Landmark STD Code Tel

Permanent Address

District State Code Pin

City/ Town/ Village Location Category: Rural Semi-urban Urban Metro

Mobile No. Email ID

Residential status: Resident Individual NRI PIO Foreign National UID No.

✔ ✔ ✔ ✔ ✔ ✔ ✔ U ✔ ✔ ✔ ✔

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Name

Date of Birth Gender : Male Female Transgender Marital status: Married Single Others

Current Address

City/ Town/ Village

STD Code Tel

Nearest Landmark

Residence is: Self-owned Rented Company provided Other Years Months, if rented, monthly rent No. of years at above residence

Residence type: Bungalow(B) Row House(R) Flat(F) Other(O) Permanent Address

Location Category: Rural Semi-urban Urban Metro City/ Town/ Village

Mobile No. Email ID

No. of Dependents Alternate E-maiI ID

Gross Income PA UID No.

Relationship with applicant: Father Mother Brother Spouse Sister Others Residential status: Resident Individual NRI PIO Foreign National UID No.

D D M M Y Y Y Y

Education: Post Graduate Professional Diploma Holder Graduate Under Graduate/ Matriculate Co-applicant’s Maiden Name

Emp. ID Comp. / Employers(N) Company/ Employers City State Tel(O)

Occupation: Salaried Self employed/ Business Self employed professional Retired O t h e rs

Employer / Business Details

Designation Exp. in Current job/ Business Yrs Months Total Exp. in job/ Business Yrs Months

PIN Code Country Previous Employers Name

Mobile

Course Approved by: UGC Govt. AICTE Other Course Stream: Medical Engineering Management Others

Type of course: Part time Full time Executive

Applicant Occupational Details

Address

Personal Details of the Co-applicant

COURSE COST DETAILS FUNDS AVAILABLE DETAILS Own Source

Scholarship

Others

TOTAL 2

GRAND TOTAL (TOTAL 1 + TOTAL 2)

Education Loan Details

Tuition Fees Examination Fees Cost of Study Materials Traveling Expenses Others if any

TOTAL 1

COURSE COST DETAILS

Tuition Fees Examination Fees Cost of Study Materials Traveling Expenses Others if any

TOTAL 1

FUNDS AVAILABLE DETAILS Own Source

Scholarship

Others

TOTAL 2

GRAND TOTAL (TOTAL 1 + TOTAL 2)

Education Loan Details

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Occupation: Salaried Self employed/ Business Self employed professional Retired O t h e rs Official e-mail ID Office Ownership Comp. / Employers(N) Company/ Employers Landmark City State Tel(O)

Self Owned Parental Relatives Rental Pagdi Others

PIN Code Country Mobile

Other monthly income Emp. ID

Previous Employers Name

Designation Exp. in Current job/ Business Yrs Months Total Exp. in job/ Business Yrs Months

Assets Liabilities

PAN Card (Applicant) PAN Card (Co-Applicant)

Form 60/61 Declaration (to be filled in by those who do not have either PAN or GIR)

Occupational Details

PAN/ GIR No. of First Applicant

Occupational Details

Address

Assets & Liabilities

Applicant Co-applicant Bank1 Bank 2 Bank Balance BB Amount Bank Deposit BD Amount Immovable properties Mutual Funds Others Bank1 Bank 2

Bank Account details

Particulars Applicant Co-applicant

Account number Type

Name of the bank Bank Branch

Project approved by ICICI Bank, Yes No

Address

Property Owned by _______________________________ Current Value ___________________________

Details of security offered

Type of Property: Residence Commercial Plot FD Others Specify_____________ Security offered : Yes No

Proof of Address (POA)

Applican

t

CURRENT / PERMANENT / OVERSEAS ADDRESS DETAILS (Certified copy of any one of the following POA needs to be submitted)

Address Type Residential / Business Residential Business Registered Office Unspecified Proof of Address Aadhar* Driving licence Passport Voter ID Card NREGA Job Card Other

Simplified Measures account - Document Type code

(*other OVDs are applicable only where the address mentioned in Aadhaar is not the current address of the customer)

_Applicant _Co-applicant

Home Loan Bank Home Loan Amount Vehicle/ PL Bank Vehicle/ PL Amount EL Bank

Education Loan Amount Credit Cards Others ✔ ✔ ✔ ✔ ✔ ✔ ✔

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F- NREGA Job Card E - Passport Number Expiry Date B - Voter ID Card D - Driving Licence Expiry Date D D M M Y Y Y Y

Document Type code

APPLICANT

* other OVDs are applicable only where the address mentioned in Aadhaar is not the current address of the customer

D D M M Y Y Y Y or Form 60 Form 61 A - Aadhar No.* C - PAN Card S - Simplified Measures Account Identification Number Z - Other Identification Number D D M M Y Y Y Y

Document Type code

CO-APPLICANT

* other OVDs are applicable only where the address mentioned in Aadhaar is not the current address of the customer

D D M M Y Y Y Y

or Form 60 Form 61

Proof of Identity (POI)

(Certified Copy of anyone of the following POI needs to be submitted)

Co-applicant

CURRENT / PERMANENT / OVERSEAS ADDRESS DETAILS (Certified copy of any one of the following POA needs to be submitted) Address Type Residential / Business Residential Business Registered Office Unspecified Proof of Address Aadhar* Driving licence Passport Voter ID Card NREGA Job Card Other

(*other OVDs are applicable only where the address mentioned in Aadhaar is not the current address of the customer) Current address (correspondence /local address): State/U T code : ISO 3166 Country code:

Permanent address : State/U.T code: ISO 3166 Country code: Overseas Address: ISO 3166 Country code:

TICK IF APPLICABLE RESIDENCE FOR TAX PURPOSES IN JURISDICTION(S) OUTSIDE INDIA

Place / City of Birth ISO 3166 Country code of Jurisdiction of Residence Tax Identification Number or equivalent (if issued by jurisdiction) ISO 3166 Country Code of Birth

Proof of Address (POA)

Checklist Of Document Sharing

Applicant Co-Applicant Additional Co-Applicant Guarantor

2 Color Photos Photo ID Residence Proof Date of Birth Proof Signature Verification Academic Documents Proof of Admission Fees Structure 2 Color Photos Photo ID Residence Proof Date of Birth Proof Signature Verification 8 Months Bank Statement Income Proof Collateral Documents Relationship Proof 2 Color Photos Photo ID Residence Proof Date of Birth Proof Signature Verification Income Proof Collateral Documents 2 Color Photos Photo ID Residence Proof Date of Birth Proof Signature Verification 8 Months Bank Statement Income Proof

Collateral Documents Relationship Proof

( *Compulsory one reference should be relative)

Name Address E-mail ID Name* Address E-mail ID 1. 2. Relationship Relationship Phone Phone

( Preferably friend/ colleague)

Reference

✔

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SPECIMEN SIGNATURE(Applicant) SPECIMEN SIGNATURE(Co-Applicant)

Common Declarations

I ____________________________ with employee ID/ VSTS Code ____________________________ do hereby confirm that I have met Applicant / Authorised Signatory in person at his / her office / residence on __________________________ (mention date) and confirm that I have verified the copies of documents (as applicable) against original as produced by the applicant. I also confirm that Applicant(s) have signed this application form in my presence.

Signature of Bank Official / Outsourced Executive: ____________________________________

Declaration

I/We have no objection to ICICI Bank Limited, its group companies, agents/representatives to provide me/us information on various products, offers and 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/ representatives for the above purpose. Please tick Yes or No, as acceptable.

1. 4. 2. 3. 5. 6. 7. 8. 9. 10.

(*subject to change as per bank discretion from time to time) Details of the Charges

Interest Rate * % per annum

Processing Fee ( one time ) * Prepayment charges * Other charges *

KYC Certification (To be filled by Bank Official / Sourcing Agent)

Yes No

deem fit and shall not hold ICICI Bank (or any of its Group Companies or its/their agents / representatives) liable for use / sharing of this information.

I/We further authorize ICICI Bank to submit/disclose the 'financial information' as defined in Section 3(13) of the Insolvency and Bankruptcy Code, 2016 ("IBC") (including all amendments and replacements made thereto and all rules and regulations framed thereunder) in relation of the loan facility availed by me/us to an Information Utility as defined in Section 3(21) of IBC. I/We further agree to promptly authenticate and verify the ·financial information· submitted by ICICI Bank, as and when requested by Information Utilities"

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/ use of such rejection, of our application.

Except to the extent disclosed to ICICI Bank, no director or 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 our concern, or a trustee,member, director, manager, employee of our 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. For the purpose of this clause the terms "relative", "near relation" & "senior officer" shall have the same meaning ascribed to them under the RBI master circular on Loans and Advances dated July 1, 2015, para 2.2.1.8 and shall include any amendments made thereto."

I hereby authorize ICICI Bank to validate my Aadhar details from UIDAI.

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. 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 not withheld any information whatsoever.

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 misrepresenting. I am aware that I may be held liable for it. I hereby consent to receiving information from Central KYC Registry through SMSs/ Email on the above registered number/ email address.

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 never been adjudicated insolvent by any court or other authority.

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.

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 collecting my/our application. I / We shall not hold ICICI Bank liable for any such payment made by us to the executive collecting this application.

I/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 to ICICI Bank shall have the right to retain the same in accordance with ICICI Bank Ltd’s internal policy and applicable laws and regulations.

I/We authorize ICICI Bank Limited (ICICI Bank) to exchange, share or part with all the information and details relating to my/our existing loan and/or repayment history to other ICICI group companies, banks, financial institutions, credit bureaus, statutory bodies, such other Agencies enrolled by ICICI Bank for the purpose of providing the products and services as may be required or they may

End Use Declarations

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, acquiring equity shares of Indian company/ ies, buyback of shares of Indian company, funding of promoters contribution in the project or any other purpose, which is prohibited or any illegal activity.

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Aadhaar Updation Consent Form

The Branch Manager

ICICI Bank Ltd.,

______________________(Branch Name)

I, Mr./Ms.,___________________________________,in my capacity as an Individual / Proprietor / Partner / Authorised Signatory / Beneficial Owner of _____________________________________________________________________, (“Account Title”) hereby voluntarily submit my Aadhaar number _______________________________________for opening of account (with Application No./ Bar code No. specified below) and / or linking / updating Aadhaar No in the below mentioned account(s).A copy of my duly self-attested Aadhaar card is enclosed.

D D M M Y Y Y Y

Date

Customer ID

Bar Code No. /

Application No. /

Account No.

Account Title

Type of Account

1 I voluntarily give my consent to ICICI Bank Ltd. for: (a)Using my Aadhaar details for authenticating my identity with UIDAI's Aadhaar based authentication system and obtaining demographic details (including photograph) from UIDAI; (b) Use of my registered mobile number to receive SMS alerts from ICICI Bank regarding Aadhaar; and (c) Sharing my Aadhaar details with UIDAI, concerned regulatory and / or statutory authorities as may be required under applicable law(s).

2 I have been informed that: (a) my 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; and (b) my biometric information will not be stored by the Bank.

3 I hereby understand that My request for updation of Aadhaar details will not be processed, if (a) Aadhaar details provided by me is incorrect;

(b) authentication with UIDAI fails due to mismatch of my details with UIDAI; (c) there is technical failure while authenticating Aadhaar details with UIDAI.

Signature of the Aaadhar holder Sincerely,

Enclosure: Copy of duly self-attested Aadhaar card

Acknowledgment Receipt

To,

ICICI Bank has received your application of Rs

Please note that the processing of your application may take upto 15 working days after receipt of the completed application form with requisite documents. In case of queries, please contact:

Relationship Manager Number

Sales Executive/ DSA Number

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ANNEXURE (Co-Applicant/ Guarantor)

PAN Card Form 60/61 Declaration (to be filled in by those who do not have either PAN or GIR)

PAN/ GIR No. of Co-applicant / Guarantor

Particulars Co-applicant / Guarantor

Account number Type

Name of the bank Bank Branch

Bank Account details

Emp. ID Comp. / Employers(N) Company/ Employers Address Landmark City State Tel(O) Official e-mail ID Office Ownership

Occupation Salaried Self employed/ Business Self employed professional Retired O t h e rs

PIN Code Country Mobile

Designation Exp. in Current Job/ Business Yrs Months Total Exp. in Job/ Business Yrs Months Previous Employers Name

Personal Details of the Co-applicant

Name

Date of Birth Gender: Male Female Transgender Marital status: Married Single Others Education: Post Graduate Professional Diploma Holder Graduate Under Graduate/ Matriculate

Current Address

City/ Town/ Village District State Code Pin

Residence is: Self-owned Rented Company provided Other No. of years at above residence Years Months, if rented, monthly rent Residence type: Bungalow(B) Row House(R) Flat(F) Other(O) Permanent Address

City/ Town/ Village Location Category: Rural Semi-urban Urban Metro

Mobile No. Email ID

No. of Dependents Alternate E-maiI ID

Gross Income PA UID No.

Relationship with applicant: Father Mother Brother Spouse Sister Others Residential status: Resident Individual NRI PIO Foreign National UID No.

D D M M Y Y Y Y

Occupational Details

Self Owned Parental Relatives Rental Pagdi Others

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Proof of Address (POA)

Co-applicant / Guarantor

SPECIMEN SIGNATURE(Applicant) SPECIMEN SIGNATURE (Co-applicant/ Guarantor) 3 Please Affix Recent Passport size Photograph (Self attested)

(*subject to change as per bank discretion from time to time)

Details of the Charges

Interest Rate * % per annum

Processing Fee ( one time ) *

Prepayment charges * Nil

Other charges *

CURRENT / PERMANENT / OVERSEAS ADDRESS DETAILS (Certified copy of any one of the following POA needs to be submitted) Address Type Residential / Business Residential Business Registered Office Unspecified Proof of Address Aadhar* Driving licence Passport Voter ID Card NREGA Job Card Other

(*other OVDs are applicable only where the address mentioned in Aadhaar is not the current address of the customer) Current address (correspondence /local address): State/U T code : ISO 3166 Country code:

Permanent address : State/U.T code: ISO 3166 Country code: Overseas Address: ISO 3166 Country code:

TICK IF APPLICABLE RESIDENCE FOR TAX PURPOSES IN JURISDICTION(S) OUTSIDE INDIA

Place / City of Birth ISO 3166 Country code of Jurisdiction of Residence Tax Identification Number or equivalent (if issued by jurisdiction) ISO 3166 Country Code of Birth

E . Passport Number Expiry Date

F. NREGA Job Card

Z. Other (any document notified by government) Identification Number

S. Simplified Measures Account- Document Type Code Identification Number

A. Aadhar* (*other OVDs are applicable only where the address mentioned in Aadhaar is not the current address of the customer)

B. Voter ID Card D. Driving Licence D D M M Y Y Y Y C. PAN Card* D M Y Expiry Date

Proof of Identity (POI)

Co-applicant / Guarantor

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

D M Y Y Y

References

Co-applicant / Guarantor

Name Address E-mail ID 1. 2. Relationship Phone Phone Relationship

( *Compulsory one reference should be relative) ( Preferably friend/ colleague)

Name* Address E-mail ID

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SPECIMEN SIGNATURE(Applicant) SPECIMEN SIGNATURE(Co-Applicant/ Guarantor)

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 not withheld 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 misrepresenting. I am aware that I may be held liable for it. I hereby consent to receiving information from Central KYC Registry through SMSs/ Email on the above registered number/ email address.

3. 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 never been adjudicated insolvent by any court or other authority.

4. 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.

5. 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 collecting my/our application. I / We shall not hold ICICI Bank liable for any such payment made by us to the executive collecting this application.

6. I/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 to ICICI Bank shall have the right to retain the same in accordance with ICICI Bank Ltd’s internal policy and applicable laws and regulations.

7. I/We authorize ICICI Bank Limited (ICICI Bank) to exchange, share or part with all the information and details relating to my/our existing loan and/or repayment history to other ICICI group companies, banks, financial institutions, credit bureaus, statutory bodies, such other Agencies enrolled by ICICI Bank for the

End Use Declarations

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, acquiring equity shares of Indian company/ ies, buyback of shares of Indian company, funding of 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.

Common Declarations

Declaration

I ____________________________ with employee ID/ VSTS Code ____________________________ do hereby confirm that I have met Applicant / Authorised Signatory in person at his / her office / residence on __________________________ (mention date) and confirm that I have verified the copies of documents (as applicable) against original as produced by the applicant. I also confirm that Applicant(s) have signed this application form in my presence. Signature of Bank Official / Outsourced Executive: ____________________________________

KYC Certification (To be filled by Bank Official / Sourcing Agent)

I/We have no objection to ICICI Bank Limited, its group companies, agents/representatives to provide me/us information on various products, offers and services provided by ICICI Bank Limited/its group companies through any mode (including without limitation through telephone calls/ SMSs/ emails) and authorize ICICI

purpose of providing the products and services as may be required or they may deem fit and shall not hold ICICI Bank (or any of its Group Companies or its/their agents / representatives) liable for use / sharing of this information. I/We further authorize ICICI Bank to submit/disclose the

'financial information' as defined in Section 3(13) of the Insolvency and Bankruptcy Code, 2016 ("IBC") (including all amendments and replacements made thereto and all rules and regulations framed thereunder) in relation of the loan facility availed by me/us to an Information Utility as defined in Section 3(21) of IBC. I/We further agree to promptly authenticate and verify the ·financial information· submitted by ICICI Bank, as and when requested by Information Utilities"

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/use of such rejection, of our application.

Except to the extent disclosed to ICICI Bank, no director or 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 our concern, or a trustee,member, director, manager, employee of our 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. For the purpose of this clause the terms "relative", "near relation" & "senior officer" shall have the same meaning ascribed to them under the RBI master circular on Loans and Advances dated July 1, 2015, para 2.2.1.8 and shall include any amendments made thereto." I hereby authorize ICICI Bank to validate my Aadhar details from UIDAI.

8.

9.

10.

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