Article Structure
The ICICI Pay Direct Card application process begins with a comprehensive form designed to collect essential information about the applicant. This form, last updated in September 2004, includes various sections that are crucial for verifying identity and processing the application efficiently. Required fields encompass personal details like the applicant's name, address, and date of birth. Additionally, it mandates identity proof, with a list of acceptable documents ranging from a passport to employee identity cards. Contact information is necessary, including phone numbers for verification purposes. The form serves as a declaration, ensuring that the details provided are accurate and up-to-date. It also outlines the responsibilities of the applicant, including adherence to terms and conditions of the card, understanding any associated fees, and the necessary confirmation of identity and employment details. The process of signing the form involves the applicant, along with verification signs from bank officials, ensuring a dual layer of security and compliance. Charges for the card initiation are stipulated along with a requirement for a one-time payment via demand draft, ensuring transparency in costs from the outset. This thorough exploration of details within the application form emphasizes ICICI's commitment to safeguarding and validating applicants' information right from the beginning.
Icici Pay Direct Card Example
Ref No:
Card No:
Branch Code:
DMA Code:
Company PPA Code:
Pricing Code:
Application No. :
Version 3,September 2004.
Pay Direct Card / Meal Card Application Form
FIELDS WITH |
ARE MANDATORY |
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Branch : |
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Date : |
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I / We hereby apply for Pay Direct Card / Meal Card with your bank. |
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P E R S O N A L D E T A I L S |
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*New Applicant: |
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Mr. / Ms. / Dr. |
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First Name |
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Middle Name |
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Last Name |
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*Date of Birth : |
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*Flat No./Society Name :
*Road No./Name :
*Nearest Landmark :
*City :
*Tel. No. : |
STD Code |
*Mother’s Maiden Name :
*Permanent Address :
C O M M U N I C A T I O N A D D R E S S
(R) |
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(O) |
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Mobile |
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(This information may be used to verify your identity when you want your card account details over phone.)
*City :
*State :
*PIN :
STD code : |
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Tel. : |
IDENTITY PROOF
( Verified true copy of any one of the following valid documents duly verified with the originals by a bank official):
Passport
Original Letter of introduction from existing bank
Driving Licence
Voters identity cards
Employee identity cards
PAN Card
Photo Credit Card along with the current billing cycle (latest) statement
Arms licence issued by state/ Central Government of India authority with photograph of applicant
Pension book issued by Government of India with photograph of applicant containing name, address and validity period.
Freedom fighters pass issued by home ministry of government of India with photograph of applicant
For married women, proof of identity with her maiden name, if supported with a verified true copy of marriage certificate are acceptable as valid identity proof.
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* PAN/ GIR No. Of First Applicant : |
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FROM 60 / 61 ( TO BE FILED BY THOSE WHO DO NOT HAVE EITHER PAN OR GIR ) |
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OR |
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Are you a Tax Assessee |
Yes |
No |
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If yes, (a) Details of ward/ Circle/Range ware the last return of income was filed
(b) Reason for not having PAN/GIR No. :
*(Copy of Pancard Mandatory )
I |
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do hereby declare that what is stated is true to the best of my knowledge and belief. |
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Verified at |
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this the |
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day of |
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200 |
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Signature of the declarant
A B O U T Y O U R W O R K
*Name of the Company :
*Department :
*Office Address :
* City :
* STD code : |
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Tel. : 1 |
Address & Signature verified as per the company records
Name of Authorised Signatory :
Tel. : 2
PIN :
Extn. No . :
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Company Official’s Signature Verified |
Date : |
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Signature with Seal |
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by the Bank Officer (AM & Above/SE/BDE) |
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S I G N A T U R E S A N D P H O T O G R A P H S
Signature of Bank official in whose presence signed
Date :
DDMMYYYY
Applicant’s
Photo
Please affix a recent photograph. Please sign in black ink within the box
Signature of applicant
C A R D C H A R G E S
Card Charges for Rs. 200/- one time fees to be paid in Demand Draft Drawn in favour of “ICICI Bank Limited” and Attach with the Application Form
D E C L A R A T I O N
I have understood and here by agree to the Terms and Conditions as applicable to my Card set forth on the website www.icicibank.com. I understand that Access to any changes/Updating in terms and conditions applicable to this relationship would be available on the website only. I do hereby declare that information furnished in this form is true to the best of my knowledge and belief.
I declare, confirm, agree:
•That all the particulars and information given in this application form ( and all documents referred or provided therewith ) are true, correct, complete and
•That I have had no insolvency proceedings initiated against me nor have I ever been adjudicated insolvent.
•That I have read the application form and brochures and am/are aware of all the terms/conditions of availing finance or service or products from ICICI Bank an its group companies and/or its and ICICI Bank.
•I agree and understand that ICICI Bank limited / Group Companies reserve the right to reject any application without providing any reason. I agree and understand that ICICI Bank Ltd. /Its Group Companies reserve the right to retain the application forms, and the documents provide therewith, including photographs and will not return the same to me.
•I have also read and understood Terms and conditions under which the scheme is offered to my organisation and its employees.
•I agree that my employer has full right to revers an instruction given by them for any amount within a period of three working days and I will not dispute or hold the bank responsible for any such debits on the Card.
I understand that it is my responsibility to inform ICICI Bank immediately on termination of my employment with my current employer whereupon I will cease to enjoy any or all benefits under this scheme.
ICICI Bank/its Group Companies or there agents to make references and enquires which ICICI Bank Ltd./ Its Group Companies consider necessary in respect of or relation to information in this application. To inform ICICI Bank & its Group Companies regarding change in my residence / employment and to provide any further information that ICICI Bank & its Group Companies may require from time to time. ICICI Bank Ltd. / its Group Companies to exchange share or part with all the information data or documents relating to my application to other ICICI Group Companies/ Bank/ Financial Instruction / Credit bureaus / Agencies Statutory Bodies such other persons as ICICI Bank Ltd. /Its Group Companies may deem necessary or appropriated as may be required for use or processing of the said information/data by such person or fumishing of the processed information/data/products thereof to other Banks/Financial Institutions / Credit provider /users registered with such persons and shall not hold ICICI Bank Ltd./its Group Companies liable for use of this information
I agree and understand that I have to complete further applications for specific liability products services from ICICI Bank Ltd./ Its Group Companies as prescribed from time to time and that such further application shall be regarded as an integral part of this application and vice versa and that unless otherwise disclosed in such further forms are prescribed the particulars and information set forth herein as well as the documents referred or provide herewith are true, correct, complete and
I authorise ICICI Bank Ltd. to issue an ICICI Bank Pay Direct Card / Meal Card / Reimbursement Card to me. I acknowledge that the issue and usage of the Pay Direct Card / Meal Card / Reimbursement Card is governed by the terms and conditions as in force from time to time and agree to be bound by the same. I accept that the terms and condition of Pay Direct Card / Meal Card / Reimbursement Card are liable to be amended by ICICI Bank Ltd. from time to time. I further unconditionally and irrevocably authorise ICICI Bank Ltd. To debit my Account annually with an amount equivalent to the fee and charges for use of the card. I hereby confirm that this account will be operated singly.
The Applicant/s has/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 authorise ICICI Bank Limited, its group companies, agents/representatives for the above purpose.
(Please tick Yes or No, as acceptable to the Applicant/s) : Y: |
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OR N: |
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Signature of Applicant
KYC CERTIFICATION FOR NEW CUSTOMERS
*Name of the Bank Official / SE / BDE
Employee No.
* Date :
DD
MM
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Signature of Bank Official / SE / BDE and Branch stamp with Branch Code |
FOR ICICI BANK USE ONLY
Charged Kit.: |
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Yes |
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No |
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Documentation Completed and form submitted on:Date : |
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Account Opening Form scrutinized and found in Date : |
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order Channel Registration Approved by : |
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Checked by DVU Official at RPC |
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If rejected, reason: |
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Form Scanned on : |
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Scanned image transfered on : Date : |
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SE / BDE / BM / BOM Signature
Signature
Please affix Acknowledgement for WELCOME KIT received from Account holder
Form Characteristics
| Fact Name | Description |
|---|---|
| Form Purpose | The ICICI Pay Direct Card form is used to apply for a Pay Direct Card or Meal Card from ICICI Bank. |
| Mandatory Fields | Applicants must complete several mandatory fields, including personal details and identity proof. |
| Identity Proof | Verification requires a true copy of a valid identity document, such as a passport, driving license, or PAN card. |
| Application Fee | A one-time fee of Rs. 200 must be paid via Demand Draft along with the application form. |
| Governing Laws | The form is governed by banking regulations in India. Specific rules may vary by state. |
Guidelines on Utilizing Icici Pay Direct Card
After gathering the necessary details, you can proceed to fill out the ICICI Pay Direct Card form. Ensure that you have the required identity documents and photograph ready for submission along with your application.
- Start by entering the reference number, card number, branch code, DMA code, company PPA code, and pricing code at the top of the form.
- Fill in the application number along with the date of application in the specified format (DD MM YYYY).
- Indicate whether you are a new applicant and provide your title (Mr., Ms., Dr.) alongside your first name, middle name, and last name.
- Input your date of birth in the format (DD MM YYYY).
- Complete your address details, including flat number or society name, road number or name, nearest landmark, city, and telephone number, along with the STD code.
- Provide your mother’s maiden name and email ID.
- Enter your permanent address, ensuring to fill in all mandatory fields.
- For the communication address, indicate whether it is residential or office, and fill in your mobile number, city, state, and PIN code.
- Choose one acceptable identity proof from the list and indicate your PAN or GIR number.
- If you do not have a PAN/GIR number, respond to the tax assess questions and provide the necessary additional details in the given space.
- Sign the declaration affirming the truthfulness of your provided information.
- In the "About Your Work" section, provide the name of your company, department, office address, city, STD code, and telephone number.
- Have the authorized signatory verify your address and signature as per company records.
- Have the bank officer sign in the specified area, and ensure the date is provided.
- Attach a recent photograph within the designated box and sign in black ink.
- Prepare a bank demand draft of Rs. 200/- in favor of “ICICI Bank Limited” to attach with your application form.
- Check the box indicating your agreement to the terms and conditions related to the card.
- Complete the KYC certification section with the name of the bank official, employee number, and signature.
What You Should Know About This Form
What is the ICICI Pay Direct Card?
The ICICI Pay Direct Card is a prepaid meal card designed to provide employees with a convenient way to pay for meals and other expenses. This card can be used at various establishments that accept card payments, offering an efficient alternative to cash transactions. It simplifies meal allowances and reimbursement processes for companies.
How do I apply for the ICICI Pay Direct Card?
To apply for the ICICI Pay Direct Card, you must complete the application form available from ICICI Bank. This form requires personal information, details about your employer, and proof of identity. After filling out the form, submit it along with a demand draft of Rs. 200/- as a one-time fee to ICICI Bank. Make sure all mandatory fields are filled in accurately to avoid delays in processing.
What documents do I need to provide?
You must provide an identity proof to verify your identity. Acceptable documents include a passport, driver's license, employee ID, or any government-issued identity card with a photograph. Additionally, a verified true copy of your PAN card is mandatory. If you do not have a PAN, you must explain your situation and provide the necessary details related to your tax assessment status.
What is the fee for the ICICI Pay Direct Card?
The ICICI Pay Direct Card incurs a one-time fee of Rs. 200/-. This amount must be paid via a demand draft made out in favor of "ICICI Bank Limited." Ensure you attach this demand draft along with your completed application form when you submit it.
What should I do if my employment status changes?
If your employment status changes, it is essential to inform ICICI Bank immediately. Upon termination of your employment with the company that issued the card, you will no longer be eligible to use the benefits associated with the ICICI Pay Direct Card. Prompt reporting of employment changes helps in preventing any misuse of the card.
How will my application be processed?
Once you submit your application, it will be scrutinized by the bank. The verification of your identity and other details will be conducted by a bank officer. If all documents are satisfactory, your request will be processed, and you will receive the ICICI Pay Direct Card. Any issues or missing information can lead to application rejection, and you will be informed of the reasons.
Can I use the ICICI Pay Direct Card at any outlet?
The ICICI Pay Direct Card can typically be used at any merchant establishment that accepts card payments under the relevant payment networks. However, it is primarily intended for meal purchases. You should confirm with specific retailers or the bank if you have questions regarding acceptance.
What happens if I lose my ICICI Pay Direct Card?
If you lose your ICICI Pay Direct Card, it is crucial to report the loss to ICICI Bank immediately. They will guide you on how to block the card to prevent unauthorized transactions. A replacement card can then be issued, but be prepared for some verification of your identity before a new card is processed.
Are the terms and conditions for the ICICI Pay Direct Card predetermined?
Yes, the terms and conditions for the ICICI Pay Direct Card are predefined. Applicants are encouraged to read all related brochures and terms thoroughly before accepting. These terms may include fee structures, card usage rules, and the process for resolving disputes. It is advisable to stay updated on any changes to these terms published on the ICICI Bank website.
Common mistakes
When applying for the ICICI Pay Direct Card, individuals often encounter various pitfalls that can hinder their application process. One common mistake is failing to complete all mandatory fields accurately. The form specifically marks certain fields with an asterisk, indicating that these are essential for processing. Omitting or incorrectly filling out these sections may lead to delays or outright rejection of the application.
Another frequent error involves providing incorrect personal information. Those filling out the application sometimes transpose digits when entering their telephone numbers or PIN codes. Such mistakes may result in miscommunication or failure to contact the applicant. Ensuring that all contact information is correct should be a priority for anyone submitting the form.
Many applicants overlook the importance of identity proof documentation. Submitting a document that is not verified or is outdated can cause significant issues. The guidelines specify that applicants need to provide verified true copies of valid identification. Not following this requirement can lead to complications in verifying one's identity, thus impeding the application process.
In the section regarding employment, some people neglect to fill in the details related to their workplace accurately. This could include the name of the company and the office address. Providing vague or incomplete information in this part of the form may lead to additional inquiries, which can further delay the acquisition of the Pay Direct Card.
A critical error that some applicants make is failing to sign the application in the required parts. The signature must be in black ink, and missing this step may render the application invalid. The form clearly states this requirement, thus drawing attention to the necessity of proper execution.
Sometimes individuals forget about the card charge payment. The form indicates that a one-time fee of Rs. 200 must be paid via Demand Draft, and applicants may overlook this step. This oversight can prevent the application from being processed altogether, halting the card issuance until the payment is made.
Another mistake occurs when applicants do not declare changes in their circumstances promptly. For example, if a person changes jobs, they must notify ICICI Bank immediately. Failing to do so could affect the benefits tied to the card, and it is crucial for applicants to remember this responsibility as they fill out the application.
Some individuals may not fully read or understand the terms and conditions associated with the Pay Direct Card. Ignoring the information provided can lead to misunderstandings regarding charges and fees in the future. It is essential to be fully aware of these details to avoid unexpected costs later on.
Lastly, a general lack of thoroughness can be a significant barrier to a successful application. It's advisable for applicants to review the entire application before submission. Taking a moment to double-check all entries, required documents, and signatures can save time and alleviate potential issues. Understanding these common mistakes will aid applicants in navigating the ICICI Pay Direct Card form with confidence and accuracy.
Documents used along the form
The ICICI Pay Direct Card application process often involves various supporting documents that help verify identity, employment, and eligibility. Here are some commonly required forms and documents that complement the Pay Direct Card form:
- Identity Proof: This includes one verified true copy of valid documents like a passport, driving license, or employee identity card. These documents establish the applicant's identity as required by the bank.
- PAN Card: The Permanent Account Number (PAN) card is mandatory for tax identification in India. It helps in verifying the applicant's financial history and obligations.
- Application Acknowledgment: This document serves as proof that the application has been received by the bank. It usually contains an acknowledgment number, date, and bank officer's signature.
- Employment Verification Letter: A letter from the employer confirming the applicant’s job position and tenure. It reinforces the individual's employment status, vital for determining eligibility.
- Document Verification Certificate: Issued by a bank official, this certificate verifies that the provided documents have been checked against the originals, ensuring authenticity.
- Proof of Address: This can be utility bills, bank statements, or lease agreements that confirm the applicant's current residential address, complementing the identity proof.
- Photo Submission: A recent passport-sized photograph is typically required. This photo may be used for the card and helps in identifying the cardholder.
- Signature Verification: A form where the applicant’s signature is validated by the bank. It ensures the signature on the card matches the one submitted during the application.
Each of these documents plays a significant role in ensuring the integrity and security of the application process. Providing accurate and complete information is essential for a smooth experience. Failing to submit the necessary documentation may delay card processing or lead to application rejection.
Similar forms
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The ICICI Pay Direct Card form shares similarities with an Application for a Credit Card. Both documents require personal and financial details from the applicant. They include sections for identity verification, financial consent, and the applicant's signature, ensuring all necessary information is accurately recorded for processing and approval.
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An Employee Benefits Enrollment Form also resembles the ICICI Pay Direct Card form. This form often includes personal details, work-related information, and declarations about understanding terms and conditions. Similar to the Pay Direct Card form, it typically requires confirmation of the information's accuracy and can involve the employer's verification.
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The Loan Application Form is another document with comparable characteristics. Both require detailed applicant information, including identity proof and employment details. They also necessitate the applicant's consent regarding data sharing with institutions for processing the application, aligning with privacy and regulatory standards.
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Lastly, a Bank Account Opening Form is similar in nature. It demands personal identification, address verification, and a declaration of the information provided. Both forms ask for a signature to verify the applicant's identity and agreement to the institution's terms, facilitating the establishment of banking relationships.
Dos and Don'ts
When filling out the ICICI Pay Direct Card form, keep these 10 tips in mind:
- Ensure all mandatory fields are filled in completely, such as name, date of birth, and address.
- Provide a valid identity proof, making sure it is verified with the originals by a bank official.
- Use clear and legible handwriting to avoid any misunderstandings.
- Attach a recent photograph signed in black ink within the designated box.
- Double-check your contact information, including mobile numbers and email addresses.
- Read through the terms and conditions carefully before signing the declaration.
- Do not leave any mandatory fields blank, even if the information seems repetitive.
- Avoid using outdated identification documents that may not be accepted.
- Do not forget to pay the card charges of Rs. 200/- through a Demand Draft.
- Refrain from providing false information; inaccuracies could lead to rejection of your application.
Misconceptions
- Misconception 1: All applicants need to provide every item listed in the form.
- Misconception 2: Identity proof is optional.
- Misconception 3: The application form can be submitted without a photograph.
- Misconception 4: The Pay Direct Card is free of charge.
- Misconception 5: Only employees of ICICI Bank can apply for this card.
- Misconception 6: You can use any type of signature on the application.
- Misconception 7: You can submit the application at any bank branch.
- Misconception 8: The terms and conditions of the card are fixed and cannot be changed.
This is not true. Only the mandatory fields marked with an asterisk (*) must be filled out for the application to be processed.
In fact, submitting a verified true copy of valid identity proof is mandatory. Without it, the application will not be accepted.
This is incorrect. A recent photograph must be affixed in the designated area on the application to proceed.
Contrary to popular belief, a one-time fee of Rs. 200 is required to be paid via demand draft attached to the application.
This is false. Any individual meeting the eligibility criteria and working for a registered company can apply.
This is misleading. The application requires a signature in black ink, specifically within the box provided for the applicant’s signature.
This is not accurate. Applications must be submitted at the designated branch specified by ICICI Bank for processing.
This is a misconception. ICICI Bank reserves the right to amend the terms and conditions, and cardholders will be notified of such changes as they occur.
Key takeaways
Applying for the ICICI Pay Direct Card can seem daunting, but understanding the key steps can simplify the process. Here are some essential takeaways to keep in mind:
- Mandatory Fields: Ensure that all mandatory fields are filled out accurately. Missing information can delay your application.
- Identity Proof: A verified true copy of valid identity proof is required. Common options include a passport, driving licence, or employee ID card.
- Signature Requirement: Sign the application form in black ink within the designated box. Ensure your signature matches the one on your identity proof.
- Photograph: A recent passport-sized photograph should be affixed to the application form.
- Card Charges: Be prepared to pay a one-time fee of Rs. 200 by demand draft. Attach this draft to your application.
- Employer Details: Fill in your company and department information accurately. This helps verify your affiliation and employment status.
- Declarations: Review the declaration section carefully. By signing it, you confirm that all information provided is true and that you understand the terms and conditions.
- Follow-Up: After submission, keep track of your application status. You may need to provide additional documentation or information upon request.
By keeping these key takeaways in mind, you can facilitate a smoother application process for your ICICI Pay Direct Card.
Browse Other Templates
Annual Wellness Visit - Keep this form with you to streamline your appointment process.
Maintenance Work Order Form - Use this form for straightforward and efficient communication regarding maintenance needs.
Standard Form 25a - Applicants must include their current and permanent mailing addresses on the form.