IBU GIFT City

Fixed Deposits (Callable) - Application Form for Individuals

To, Date:___/___/______

ICICI Bank Limited-IFSC Banking Unit,

Unit No 408, 4th Floor, Brigade International Financial Centre,
GIFT City-, Gujarat, India
382355

Subject: Request for creation of Callable Fixed Deposit (“Deposit”).

Dear Sir/Ma’am,

We, the undersigned, hereby request you to set up a Deposit as per the following instructions:

Name of the Primary Applicant

Name of the Joint Applicant/s

Account no. to be debited

Currency

Figures: ____________ Words:

Amount (in words & figures) per Deposit
_____________________________________________________________

Denomination _________ × ___________ each

Start Date

Period of Deposit (Months/Days) _________Months _________Days

Interest Rate

Deposit type With Premature withdrawal

Credit back (Both Principal and Interest) to A/c Number_______ (No Auto
Maturity Instruction(s) Renewal and Closure of FD to be done on Maturity)

Auto renewal – Both Principal and Interest

PAN Number / Form 60
Mode of Instruction Email Fax In Person
Nomination under Section 45ZA of the
Banking Regulation Act 1949, and Rule 2 Yes No

(1) of the Banking Companies (Nomination) If nomination is required,

Rules 1985, with respect to bank deposits. Same Nominee as per my/our existing savings account required.
I/We would like to provide the Nomination as per the attached
Nomination form.

If nomination is not required,

I/We have been explained about the benefits of nomination facility.

However, I/we would like to inform you that I/we do not wish to provide
nomination for the Deposit.

Signature of Applicant/s________________________________________________
(Please sign only if Nomination is not required)

Address: ICICI Bank Limited – IFSC Banking Unit, 408, Brigade International Financial Centre, GIFT City, Gandhinagar 382 355 India.
License no: IBU.06/2015 Regulated by International Financial Services Centres Authority – IFSCA 1/2
Ver 1.0 w.e.f. May 2024
 We wish to allow premature repayment of the fixed/term Deposit having operating instructions as ‘Either or Survivor’,
‘Anyone or Survivor’ or ‘Former or Survivor’ in line with the operating instructions of the Deposit. (Please note that
this clause is valid only when all the joint account holders sign the application- cum deposit slip). In case of joint fixed
/ term Deposits having operating instructions as ‘Either or Survivor’, 'Anyone or Survivor' or ‘Former or Survivor’, the
Bank shall repay the Deposit/s before the maturity of the Deposit/s in case such a request is received in accordance
with the operating instructions of the respective Deposit/s, along with relevant documents as may be specified by the
Bank from time to time. The same would be applicable even in the event of death of any of the joint depositors prior
to maturity of the Deposit. Any such repayment before maturity shall constitute a valid discharge of the Bank’s
obligations against all concerned including but not limited to the nominee / legal heirs of the Depositors or anyone
claiming under them.

DECLARATIONS
I/We hereby declare and agree that:
1. All the information provided by me/us in this application form is true and correct and no information has been
misrepresented or concealed or withheld.
2. Only simple interest as applicable shall be payable on Deposits with a tenure of 12 months and for Deposits with a
tenure exceeding 12 months, interest shall be compounded annually.
3. ICICI Bank Limited, IBU GIFT City branch (“Bank”) shall have the right to change the interest rates as per applicable
laws and regulations from time to time or otherwise and it is my/our responsibility to keep ourselves updated of the
interest rates, by checking the Bank’s website (https://www.giftcity.icicibank.com/giftcity/fixed-deposit-rates-for-
individuals) and / or by checking with the respective relationship managers (RM/s).
4. This Deposit is not covered by the deposit insurance system established by Reserve Bank of India (“RBI”).
5. In case auto-renewal is opted for by me/us:
a) The Deposit shall be auto renewed for the original period of the Deposit;
b) The interest payable shall be fixed basis the prevailing rate of interest at the time of auto renewal;
c) The mode of operation shall continue to be the same as at the time of booking the Deposit.
6. In case of premature withdrawal of the Fixed Deposit:
a) The date of premature withdrawal will be the date of request sent by me/us to the Bank for such premature
withdrawal.
b) Interest will be paid at the rate applicable on the effective date of such Deposit up to the period for which
such Deposit remained with the Bank and will be subject to payment of applicable penal charges as stated
in the Terms and Conditions.
c) The Bank shall have the right to set-off such penal charges against the Deposit and deduct the applicable
penal charges or any other charges (if due and payable). No interest will be paid if the Deposit is withdrawn
within seven (7) days.
7. I/We shall ensure compliance with the extant Foreign Exchange Management Act, 1999 (“FEMA”), Reserve Bank of
India (RBI), International Financial Services Centers Authority (“IFSCA”) regulations and any other applicable laws,
as maybe updated from time to time.
8. I/We shall provide the Bank in writing, any changes in my / our KYC details, personal details or communication
address or circumstances with updated documents within 30 days upon such change. I/We also confirm that I/we
shall inform the Bank on change of our residential status from NRI to Resident or any changes in the domicile. I/We
shall be solely responsible for ensuring that the Bank has been informed of such changes.
9. I/We have received, read and understood the General Terms and Conditions and Instructions available at -
https://www.giftcity.icicibank.com/giftcity/personal-banking/t-c-for-resident-and-non-resident-individual-accounts,
which governs the Deposits. I/We also agree to be bound by the aforesaid terms and conditions, as may be amended
from time to time (“Terms and Conditions”).
10. I/We hereby specifically agree and confirm that the Bank shall be entitled to disclose or procure information
pertaining to me/us as may be required by the Bank.

Primary Account Holder Joint Account Holder 1 Joint Account Holder 2

Signature as per
Bank records

Employee Number of Branch Official: ______________________ Branch SOL ID: _______________________

Bank
Seal
Signature of Branch Official: ______________________________

Address: ICICI Bank Limited – IFSC Banking Unit, 408, Brigade International Financial Centre, GIFT City, Gandhinagar 382 355 India.
License no: IBU.06/2015 Regulated by International Financial Services Centres Authority – IFSCA 2/2
Ver 1.0 w.e.f. May 2024