ICICI Bank Limited, CPC-Demat Services, Ground Floor, B-Wing, Autumn Estate, Chandivali Farm Road, Opp. Mhada Colony, Chandivali, Andheri (East), Mumbai - 400072.

(Important Note : Please do not send requests directly to this address. Kindly route all your requests through the nearest Demat Servicing Branches)ICICI Bank

Client IDDP IDD D M M Y Y Y YDate

Form for Subscription/Unsubscription/Updation for Mobile Alerts & Statement

Sole/First Holder

Mobile No.

E-mail

*The mobile number belongs to

*The email Id belongs to

Self Spouse Dependent Parent Dependent Children

Self Spouse Dependent Parent Dependent Children

Second Holder

Mobile No.

E-mail

*The mobile number belongs to

*The email Id belongs to

Self Spouse Dependent Parent Dependent Children

Self Spouse Dependent Parent Dependent Children

Third Holder

Mobile No.

E-mail

*The mobile number belongs to

*The email Id belongs to

Self Spouse Dependent Parent Dependent Children

Self Spouse Dependent Parent Dependent Children

(Please tick to choose a facility)

I/Wewish to register my/our e-mail Id in my Demat Account

I/Wewish to register my/our mobile number in my Demat Account and subscribe for SMS alerts

I/Wewish to unsubscribe my/our e-mail address from my Demat Account

I/We wish to request for the following services:

* Note SMS alert facility is mandatory for Demat Account operated by Power of Attorney (POA) as per regulatory guidelines.On registering your email address, the Demat statements & Annual statement will be by default sent via email.On registering your mobile number, you will be receiving SMS alerts for your Demat transactions.

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