Subscription/Unsubscription Form For Mobile Alerts or getting statements by E-mail /post

Date D D MM Y Y Y Y DP ID A/c no
Name of Sole/First Holder
Name of 2nd Holder
Name of 3rd holder
To
ICICI Bank Limited (Demat Services)
Dear Sir,
Please tick to choose a facility:
I/We wish to register my/our e-mail Id in my Demat A/c
I/We wish to register my/our mobile number in my Demat A/c
I/We wish to subscribe to your service that offers to send my/our demat account transaction statements through e-mail
I/We wish to subscribe to your service that offers to send SMS alerts of DP to my/our mobile phone.
I/We wish to unsubscribe my/our e-mail address from my Demat a/c
I/We wish to unsubscribe my/our mobile number from my/our Demat A/c for DP alerts
I/We wish to subscribe to your service that offers to send SMS alerts of NSDL to my/our mobile phone
I/We wish to unsubscibe my/our mobile number from my/our Demat A/c for NSDL alerts
I/We wish to get statements by post instead of by e-mail and be charged Rs. 50 per annum for this facility

Mobile no. E-mail Id

1ST HOLDER 1ST HOLDER

2ND HOLDER 2ND HOLDER

3RD HOLDER 3RD HOLDER

Declaration
s for usage of the Internet Banking, phone B

Terms and conditions of providing Transaction Statements to Clients by email or on website

Signature of :

(SOLE/FIRST HOLDER) (SECOND HOLDER) (THIRD HOLDER)

Page 1
 Tick for verification
Item to be checked
by branch

1 Application should be signed by all account holder.

2 If category of demat a/c is HUF , then HUF Stamp is required on application.

3 E-mail Id & mobile no should be legible.

4 Check the category of demat a/c. If a/c is NRI category, mobile alert facilities cannot be provided.

Acknowledgement
We have received your request for Mobile Alerts for the following Demat accounts :

DP ID A/c no

Received by: ..................................................................................... Office signature: ............................................................................

Branch:........................................................................................................ Date D D MM Y Y Y Y

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